{ "hospital_name": "Hospital Development Co", "last_updated_on": "2026-08-04", "version": "3.0.0", "location_name": [ "Hospital Development Co" ], "hospital_address": [ "200 Hospital Drive, , Spencer, West Virginia 25276" ], "license_information": { "state": "WV", "license_number": "74" }, "type_2_npi": [ "1316907322" ], "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Amy Downey, CFO" }, "standard_charge_information": [ { "description": "Simple pneumonia and pleurisy with cc", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 32431.35, "discounted_cash": 19458.81, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 15836.05, "10th_percentile": 15836.05, "90th_percentile": 15836.05, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 3672.90, "10th_percentile": 2458.74, "90th_percentile": 7204.19, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 3103.87, "10th_percentile": 3103.87, "90th_percentile": 3103.87, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 6717.86, "10th_percentile": 6717.86, "90th_percentile": 6717.86, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Pneumothorax with cc", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 1248.00, "discounted_cash": 748.80, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Other respiratory system diagnoses without mcc", "code_information": [ { "code": "206", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 31331.89, "discounted_cash": 18799.13, "minimum": 6967.64, "maximum": 8336.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 6967.64, "count": "1 through 10", "median_amount": 26362.36, "10th_percentile": 26362.36, "90th_percentile": 26362.36, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Cardiac arrhythmia and conduction disorders with mcc", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 27705.22, "discounted_cash": 16623.13, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Stomach, esophageal and duodenal procedures with mcc", "code_information": [ { "code": "326", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 79545.69, "discounted_cash": 47727.41, "minimum": 31354.38, "maximum": 37512.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 31354.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 37512.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 37512.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 31354.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 31354.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 31354.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 31354.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 31354.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 31354.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 31354.38, "count": "1 through 10", "median_amount": 2587.14, "10th_percentile": 2587.14, "90th_percentile": 2587.14, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Major small and large bowel procedures with cc", "code_information": [ { "code": "330", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 86543.03, "discounted_cash": 51925.82, "minimum": 17419.10, "maximum": 20840.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 20840.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 20840.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Hernia procedures except inguinal and femoral without cc/mcc", "code_information": [ { "code": "355", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 43110.83, "discounted_cash": 25866.50, "minimum": 6967.64, "maximum": 8336.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Gastrointestinal obstruction without cc/mcc", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 2282.09, "discounted_cash": 1369.25, "minimum": 6967.64, "maximum": 8336.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 6967.64, "count": "1 through 10", "median_amount": 1461.39, "10th_percentile": 1461.39, "90th_percentile": 1461.39, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Other digestive system diagnoses without cc/mcc", "code_information": [ { "code": "395", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 16278.36, "discounted_cash": 9767.02, "minimum": 6967.64, "maximum": 8336.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Appendix procedures with cc", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 21410.52, "discounted_cash": 12846.31, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 8616.63, "10th_percentile": 8616.63, "90th_percentile": 8616.63, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Cholecystectomy except by laparoscope without c.d.e. with mcc", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 10506.25, "discounted_cash": 6303.75, "minimum": 24386.74, "maximum": 29176.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 24386.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 29176.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 29176.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 24386.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 24386.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 24386.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 24386.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 24386.74, "count": "1 through 10", "median_amount": 7601.30, "10th_percentile": 7601.30, "90th_percentile": 7601.30, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 24386.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 24386.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Cholecystectomy except by laparoscope without c.d.e. without cc/mcc", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 5727.86, "discounted_cash": 3436.72, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 5113.50, "10th_percentile": 5113.50, "90th_percentile": 5113.50, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Revision of hip or knee replacement with cc", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 15415.01, "discounted_cash": 9249.01, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Aftercare, musculoskeletal system and connective tissue with cc", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 43839.83, "discounted_cash": 26303.90, "minimum": 13935.28, "maximum": 16672.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 16672.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 16672.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Skin debridement with mcc", "code_information": [ { "code": "570", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 11608.33, "discounted_cash": 6965.00, "minimum": 27870.56, "maximum": 33344.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 27870.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 33344.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 33344.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 27870.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 27870.56, "count": "1 through 10", "median_amount": 7376.25, "10th_percentile": 7376.25, "90th_percentile": 7376.25, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 27870.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 27870.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 27870.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 27870.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 27870.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Skin graft for skin ulcer or cellulitis without cc/mcc", "code_information": [ { "code": "575", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 3246.52, "discounted_cash": 1947.91, "minimum": 13935.28, "maximum": 16672.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 16672.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 16672.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 13935.28, "count": "1 through 10", "median_amount": 2586.15, "10th_percentile": 2586.15, "90th_percentile": 2586.15, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Cellulitis without mcc", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 35125.50, "discounted_cash": 21075.30, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 2792.21, "10th_percentile": 2792.21, "90th_percentile": 2792.21, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 15418.90, "10th_percentile": 15418.90, "90th_percentile": 15418.90, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 3103.87, "10th_percentile": 3103.87, "90th_percentile": 3103.87, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 9553.80, "discounted_cash": 5732.28, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 5147.80, "10th_percentile": 3294.48, "90th_percentile": 7001.12, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 3500.03, "10th_percentile": 2139.01, "90th_percentile": 6835.30, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 1085.07, "10th_percentile": 1085.07, "90th_percentile": 1085.07, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Renal failure with cc", "code_information": [ { "code": "683", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 9008.50, "discounted_cash": 5405.10, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 4917.50, "10th_percentile": 4917.50, "90th_percentile": 4917.50, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Renal failure without cc/mcc", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 18352.65, "discounted_cash": 11011.59, "minimum": 6967.64, "maximum": 8336.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 6967.64, "count": "1 through 10", "median_amount": 1676.00, "10th_percentile": 1676.00, "90th_percentile": 1676.00, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Kidney and urinary tract infections without mcc", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 36569.56, "discounted_cash": 21941.74, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 26362.36, "10th_percentile": 26362.36, "90th_percentile": 26362.36, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Red blood cell disorders with mcc", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 15348.85, "discounted_cash": 9209.31, "minimum": 13935.28, "maximum": 16672.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 16672.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 16672.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 13935.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Red blood cell disorders without mcc", "code_information": [ { "code": "812", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 6114.00, "discounted_cash": 3668.40, "minimum": 10451.46, "maximum": 12504.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 12504.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 10451.46, "count": "1 through 10", "median_amount": 4334.93, "10th_percentile": 3131.91, "90th_percentile": 5537.94, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 10451.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Lymphoma and non-acute leukemia with other procedures with mcc", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 49824.30, "discounted_cash": 29894.58, "minimum": 34838.20, "maximum": 41680.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 41680.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 41680.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 34838.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Postoperative or post-traumatic infections with o.r. procedures with cc", "code_information": [ { "code": "857", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 4009.61, "discounted_cash": 2405.77, "minimum": 17419.10, "maximum": 20840.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 20840.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 20840.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Septicemia or severe sepsis without mv >96 hours with mcc", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 30375.71, "discounted_cash": 18225.43, "minimum": 17419.10, "maximum": 20840.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 17419.10, "count": "1 through 10", "median_amount": 2988.93, "10th_percentile": 2988.93, "90th_percentile": 2988.93, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 20840.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 20840.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 17419.10, "count": "1 through 10", "median_amount": 10204.95, "10th_percentile": 4976.30, "90th_percentile": 17254.20, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 17419.10, "count": "1 through 10", "median_amount": 6938.42, "10th_percentile": 6353.87, "90th_percentile": 7522.98, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 17419.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Other factors influencing health status", "code_information": [ { "code": "951", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 11026.68, "discounted_cash": 6616.01, "minimum": 6967.64, "maximum": 8336.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH_1", "standard_charge_dollar": 8336.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO", "standard_charge_dollar": 6967.64, "count": "1 through 10", "median_amount": 4222.23, "10th_percentile": 2913.37, "90th_percentile": 5531.08, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Medicare", "plan_name": "MEDICARE", "standard_charge_dollar": 6967.64, "count": "1 through 10", "median_amount": 3103.87, "10th_percentile": 3103.87, "90th_percentile": 3103.87, "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA", "standard_charge_dollar": 6967.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Ungroupable", "code_information": [ { "code": "999", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 46151.05, "discounted_cash": 27690.63, "setting": "inpatient" } ] }, { "description": "Tirzepatide 10mg/0.6ml(zepbnd)", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "00002353311", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1678.00, "discounted_cash": 1006.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefdinir 300 mg cap", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "00093316006", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 29.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lacosamide 50mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "00131247735", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vicotza 6mg ml sol pen", "drug_information": { "unit": 6.00, "type": "ME" }, "code_information": [ { "code": "00169406012A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 870.00, "discounted_cash": 522.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ozempic 1mg/0.75ml pen inj", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "00169413001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11157.00, "discounted_cash": 6694.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ozempic 0.25mg/0.5mg pre pen", "drug_information": { "unit": 0.25, "type": "ME" }, "code_information": [ { "code": "00169418113a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 658.00, "discounted_cash": 394.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rybelsus 7mg tablet", "drug_information": { "unit": 7.00, "type": "ME" }, "code_information": [ { "code": "00169430730", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 329.00, "discounted_cash": 197.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arnuity ellipta inhalation", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00173087414", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 67.00, "discounted_cash": 40.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arnuity ellipta", "drug_information": { "unit": 14.00, "type": "EA" }, "code_information": [ { "code": "00173087614", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 89.00, "discounted_cash": 53.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Budesonide 0.5 mg/2ml prem neb", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "00186198904A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 98.00, "discounted_cash": 58.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5 1/2 ns 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00264761200", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 33.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5 1/4 ns 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00264761600", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5.45 kcl 40", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00264763800A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 56.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5rl 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00264775100a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 33.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "0.45% normal saline 1000ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00264780200", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 37.00, "discounted_cash": 22.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sterile water for inj 1000ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00264785000", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 3%", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "00338005403", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 36.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Myxredlin 100units/100ml p bag", "drug_information": { "unit": 100.00, "type": "UN" }, "code_information": [ { "code": "00338012612", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 336.00, "discounted_cash": 201.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "1/2 nss kcl 20", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00338070434", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aminosyn 4.25%/dex 10% iv sol", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00338113403", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 374.00, "discounted_cash": 224.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 25% inj", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "00409177510", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 217.00, "discounted_cash": 130.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xylocaine vl 2% 20ml", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "00409427701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 22.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 50ml vial 0.9%", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "00409488850", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cresemba 186mg cap", "drug_information": { "unit": 186.00, "type": "ME" }, "code_information": [ { "code": "00469052001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1233.00, "discounted_cash": 739.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albuterol 2.5mg/3ml inhal solu", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "00487950101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atrovent inh 2.5ml", "drug_information": { "unit": 2.50, "type": "ML" }, "code_information": [ { "code": "00487980160", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albuterol 2.5/0.5ml inhal solu", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "00487990130A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin b complex tablet", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "00536141401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetylcysteine 800mg 4ml vial", "drug_information": { "unit": 800.00, "type": "ME" }, "code_information": [ { "code": "00517760425", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Megestrol 40mg tablet", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "00555060702", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trospium chloride 20mg tablet", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "00574014560", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Actidose sorbitol 25g 120ml", "drug_information": { "unit": 25.00, "type": "GM" }, "code_information": [ { "code": "00574052074", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Actidos aqua 25 gm/120 ml", "drug_information": { "unit": 25.00, "type": "GM" }, "code_information": [ { "code": "00574052174b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dalfampridine 10mg er tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "00591253360A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 642.00, "discounted_cash": 385.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Moxifloxacin 0.5% ophthalmic", "drug_information": { "unit": 54.00, "type": "EA" }, "code_information": [ { "code": "00781713593a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30124.00, "discounted_cash": 18074.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium chloride 64mg tablet", "drug_information": { "unit": 64.00, "type": "ME" }, "code_information": [ { "code": "10006070013a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Silver nitrate swab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "12870000101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluorescein opthalmic strips", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "17238090011a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ocuvite", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "24208038762A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenylephrine 10mg/1ml inj", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "25021031501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duloxetine hcl 20 mg cap", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "27241009706a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 67.00, "discounted_cash": 40.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Icosapent ethyl 1g capsule", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "31722029912a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 18.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clobetasol prop 0.05% 50ml", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "33342032186", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aromatic ammonia inhalent", "drug_information": { "unit": 0.33, "type": "ML" }, "code_information": [ { "code": "39822990001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac tromethamine 0.5%", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42571013725A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 172.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bacitracin/neomycin/polymixin", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "45802014370A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine 4% patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "46122045021", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Voltaren 1% gel 100gm tube", "drug_information": { "unit": 100.00, "type": "GM" }, "code_information": [ { "code": "46122075252A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 122.00, "discounted_cash": 73.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Torsemide 5mg tablet", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "50268075415", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methenamine hippurate 1gm tab", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "50742014201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dorzolamide-timolol 2%-0.5%", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50742032305a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 16.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Divalproex er 500mg", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "51079076708A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 18.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clobetasol 0.05% ointment", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "51672125901a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 99.00, "discounted_cash": 59.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clobetasol propionate 0.05%", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51672129401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 63.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tranexamic acid 1000mg/100ml", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "51754010801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 242.00, "discounted_cash": 145.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rivastigmine 9.5mg/24hr patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51991089830", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 162.00, "discounted_cash": 97.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rivastigmine tartrate 6mg cap", "drug_information": { "unit": 6.00, "type": "ME" }, "code_information": [ { "code": "55111035560", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alfuzosin hcl 10mg", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "57237011490A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Etanercept 25mg/0.5ml syringe", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "58406001001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3302.00, "discounted_cash": 1981.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Menthol 89 ml tube", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "59316010212b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propafenone hcl 225mg tablet", "drug_information": { "unit": 225.00, "type": "ME" }, "code_information": [ { "code": "59651025701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac tromethamine 0.4%", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60758077305", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remdesivir 100 mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "61958290102A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1560.00, "discounted_cash": 936.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Unasyn 3.0 gm iv", "drug_information": { "unit": 3.00, "type": "GM" }, "code_information": [ { "code": "63323036920A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 44.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xylocaine epi vial 2% 20ml", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "63323048303A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 19.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetylcysteine 20% 10ml vial", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "63323069210A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 99.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brovana 15 micrograms 2ml neb", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "63402091130", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 129.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venlafaxine 37.5 mg cap", "drug_information": { "unit": 37.50, "type": "ME" }, "code_information": [ { "code": "65862052790a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clobazam 10mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "67386031401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 301.00, "discounted_cash": 180.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxcarbazepine 150mg tablet", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "68462013701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propafenone 425mg er capsule", "drug_information": { "unit": 425.00, "type": "ME" }, "code_information": [ { "code": "68462041060a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ethacrynic acid 25mg tablet", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "68682001110a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rhopressa 0.02% eye ophth sol", "drug_information": { "unit": 2.50, "type": "ML" }, "code_information": [ { "code": "70727049725", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1158.00, "discounted_cash": 694.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitrofurantoin monohydrate 100", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "70756040411A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 23.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 50% 50 ml syr", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "76329330201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dulera 100/5mcg inhaler", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "78206012702a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2672.00, "discounted_cash": 1603.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apraclonidine 1% ophthalmic sl", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "82667020001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 266.00, "discounted_cash": 159.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respite care level 1", "code_information": [ { "code": "0119", "type": "RC" } ], "standard_charges": [ { "gross_charge": 343.50, "discounted_cash": 206.10, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respite care level 2", "code_information": [ { "code": "0119", "type": "RC" } ], "standard_charges": [ { "gross_charge": 512.50, "discounted_cash": 307.50, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respite care level 3", "code_information": [ { "code": "0119", "type": "RC" } ], "standard_charges": [ { "gross_charge": 681.75, "discounted_cash": 409.05, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Room & board acute care", "code_information": [ { "code": "0120", "type": "RC" } ], "standard_charges": [ { "gross_charge": 1188.25, "discounted_cash": 712.95, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Room & board hospice ac", "code_information": [ { "code": "0120", "type": "RC" } ], "standard_charges": [ { "gross_charge": 1188.25, "discounted_cash": 712.95, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Room & board hospice nf", "code_information": [ { "code": "0120", "type": "RC" } ], "standard_charges": [ { "gross_charge": 335.00, "discounted_cash": 201.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Room & board swing", "code_information": [ { "code": "0120", "type": "RC" } ], "standard_charges": [ { "gross_charge": 847.25, "discounted_cash": 508.35, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Room & board nursing facility", "code_information": [ { "code": "0190", "type": "RC" } ], "standard_charges": [ { "gross_charge": 335.00, "discounted_cash": 201.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anesth surg upper abdomen", "code_information": [ { "code": "00790", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11.75, "discounted_cash": 7.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anesthesia intraperitoneal pro", "code_information": [ { "code": "00790", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11.75, "discounted_cash": 7.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anes upr lwr gi ndsc px", "code_information": [ { "code": "00813", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17.75, "discounted_cash": 10.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anesthesia upr lwr gi", "code_information": [ { "code": "00813", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17.75, "discounted_cash": 10.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anesth knee area surgery", "code_information": [ { "code": "01360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5880.00, "discounted_cash": 3528.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj algc cell fluor lmbr 1st", "code_information": [ { "code": "0627T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perq njx algc fluor lmbr 1st", "code_information": [ { "code": "0627T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx b1 sub mtrl sbchdrl dfct", "code_information": [ { "code": "0707T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2835.00, "discounted_cash": 1701.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fna bx w/us gdn 1st les", "code_information": [ { "code": "10005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2460.50, "discounted_cash": 1476.30, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 610.21, "10th_percentile": 610.21, "90th_percentile": 610.21, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 151.45, "10th_percentile": 151.45, "90th_percentile": 151.45, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 523.26, "10th_percentile": 463.46, "90th_percentile": 583.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fna bx w/o img gdn 1st les", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10675.75, "discounted_cash": 6405.45, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29936.66, "discounted_cash": 17962.00, "minimum": 176.75, "maximum": 518.20, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 439.16, "10th_percentile": 439.16, "90th_percentile": 439.16, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 359.79, "10th_percentile": 352.53, "90th_percentile": 367.05, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.30, "10th_percentile": 52.31, "90th_percentile": 54.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.28, "10th_percentile": 46.14, "90th_percentile": 48.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.57, "10th_percentile": 57.57, "90th_percentile": 57.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 518.50, "discounted_cash": 311.10, "minimum": 176.75, "maximum": 518.20, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 439.16, "10th_percentile": 439.16, "90th_percentile": 439.16, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 359.79, "10th_percentile": 352.53, "90th_percentile": 367.05, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.30, "10th_percentile": 52.31, "90th_percentile": 54.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.28, "10th_percentile": 46.14, "90th_percentile": 48.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.57, "10th_percentile": 57.57, "90th_percentile": 57.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29936.66, "discounted_cash": 17962.00, "minimum": 355.39, "maximum": 1041.96, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "1 through 10", "median_amount": 535.86, "10th_percentile": 535.86, "90th_percentile": 535.86, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "1 through 10", "median_amount": 94.10, "10th_percentile": 94.10, "90th_percentile": 94.10, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 192.83, "10th_percentile": 177.59, "90th_percentile": 201.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26588.23, "discounted_cash": 15952.94, "minimum": 355.39, "maximum": 1041.96, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "1 through 10", "median_amount": 535.86, "10th_percentile": 535.86, "90th_percentile": 535.86, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "1 through 10", "median_amount": 94.10, "10th_percentile": 94.10, "90th_percentile": 94.10, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 192.83, "10th_percentile": 177.59, "90th_percentile": 201.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of pilonidal cyst", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1839.75, "discounted_cash": 1103.85, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage pilonidal cyst simple", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1839.75, "discounted_cash": 1103.85, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of pilonidal cyst", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2391.50, "discounted_cash": 1434.90, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d pilonid cyst complex", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2391.50, "discounted_cash": 1434.90, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision & removal fb simple", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29936.66, "discounted_cash": 17962.00, "minimum": 355.39, "maximum": 1041.96, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision & removal fb complex", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5406.50, "discounted_cash": 3243.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29936.66, "discounted_cash": 17962.00, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5406.50, "discounted_cash": 3243.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of hematoma/fluid", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5406.50, "discounted_cash": 3243.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "1 through 10", "median_amount": 4332.23, "10th_percentile": 4332.23, "90th_percentile": 4332.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d hematoma seroma fluid", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5406.50, "discounted_cash": 3243.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "1 through 10", "median_amount": 4332.23, "10th_percentile": 4332.23, "90th_percentile": 4332.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Puncture aspiration abscess", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Puncture drainage of lesion", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16125.40, "discounted_cash": 9675.24, "minimum": 355.39, "maximum": 1041.96, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Puncture drainage of lesion", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complex drainage wound", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11213.50, "discounted_cash": 6728.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d post op infection", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11213.50, "discounted_cash": 6728.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride infected skin", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1279.00, "discounted_cash": 767.40, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debridement infected skin", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1279.00, "discounted_cash": 767.40, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debr necrotiz stiss - abd wall", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2055.50, "discounted_cash": 1233.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride abdom wall", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2055.50, "discounted_cash": 1233.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove mesh from abd wall", "code_information": [ { "code": "11008", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 722.75, "discounted_cash": 433.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride skin at fx site", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14161.42, "discounted_cash": 8496.85, "minimum": 625.85, "maximum": 1834.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride skin at fx site", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2391.50, "discounted_cash": 1434.90, "minimum": 625.85, "maximum": 1834.94, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride skin sc tissue open fx", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2391.50, "discounted_cash": 1434.90, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9111.00, "discounted_cash": 5466.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb subq tissue 20 sq cm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14161.42, "discounted_cash": 8496.85, "minimum": 355.39, "maximum": 1041.96, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "132", "median_amount": 292.45, "10th_percentile": 248.39, "90th_percentile": 437.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.16, "10th_percentile": 49.76, "90th_percentile": 104.92, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 186.29, "10th_percentile": 186.29, "90th_percentile": 206.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.48, "10th_percentile": 97.48, "90th_percentile": 97.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb subq tissue 20 sq cm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1187.27, "discounted_cash": 712.36, "minimum": 355.39, "maximum": 1041.96, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "132", "median_amount": 292.45, "10th_percentile": 248.39, "90th_percentile": 437.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.16, "10th_percentile": 49.76, "90th_percentile": 104.92, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 186.29, "10th_percentile": 186.29, "90th_percentile": 206.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.48, "10th_percentile": 97.48, "90th_percentile": 97.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb musc/fascia 20 sq cm/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14161.42, "discounted_cash": 8496.85, "minimum": 544.50, "maximum": 1596.42, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb musc/fascia 20 sq cm/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride muscle fascia 1st 20cm", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb bone 20 sq cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb bone 20 sq cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30466.92, "discounted_cash": 18280.15, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb bone 20 sq cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30466.92, "discounted_cash": 18280.15, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb subq tissue add-on", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14161.42, "discounted_cash": 8496.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 76.01, "10th_percentile": 76.01, "90th_percentile": 76.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb subq tissue add-on", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1405.61, "discounted_cash": 843.37, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 76.01, "10th_percentile": 76.01, "90th_percentile": 76.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb musc/fascia add-on", "code_information": [ { "code": "11046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 503.00, "discounted_cash": 301.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride muscle fascia ea+ 20cm", "code_information": [ { "code": "11046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 503.00, "discounted_cash": 301.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb bone add-on", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb bone add-on", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 740.75, "discounted_cash": 444.45, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride bone ea+ 20 sq cm", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 740.75, "discounted_cash": 444.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim skin lesion", "code_information": [ { "code": "11055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim 2-4 lesions", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim skin lesions 2 to 4", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim > 4 lesions", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim skin lesions over 4", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tangential biopsy skin 1 les", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tangntl bx skin single les", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tangential biopsy skin ea+ les", "code_information": [ { "code": "11103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 45.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tangntl bx skin ea sep/addl", "code_information": [ { "code": "11103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 45.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Punch biopsy skin 1 lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Punch bx skin single lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Punch biopsy skin ea+ lesion", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.75, "discounted_cash": 52.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Punch bx skin ea sep/addl", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.75, "discounted_cash": 52.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incal bx skn single les", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1548.25, "discounted_cash": 928.95, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incisional biopsy skin 1 les", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1548.25, "discounted_cash": 928.95, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inc biopsy skin ea+ lesion", "code_information": [ { "code": "11107", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 106.25, "discounted_cash": 63.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incal bx skn ea sep/addl", "code_information": [ { "code": "11107", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 106.25, "discounted_cash": 63.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rem skin tags <=15 lesions", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 849.75, "discounted_cash": 509.85, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of skin tags 4.0 cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26337.26, "discounted_cash": 15802.36, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 665.22, "10th_percentile": 665.22, "90th_percentile": 665.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc benign lesion snhfg =<0.5", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc benign lesion snhfg 0.6-1.", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 400.00, "discounted_cash": 240.00, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 625.85, "maximum": 1834.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 400.00, "discounted_cash": 240.00, "minimum": 625.85, "maximum": 1834.94, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc benign lesion snhfg 1.1-2.", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 464.75, "discounted_cash": 278.85, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 464.75, "discounted_cash": 278.85, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc benign lesion snhfg 2.1-3.", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4991.00, "discounted_cash": 2994.60, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4991.00, "discounted_cash": 2994.60, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc benign lesion snhfg 3.1-4.", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 565.75, "discounted_cash": 339.45, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 565.75, "discounted_cash": 339.45, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc benign lesion snhfg >4.0", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 584.00, "discounted_cash": 350.40, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg >4 cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15611.20, "discounted_cash": 9366.72, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg >4 cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 584.00, "discounted_cash": 350.40, "minimum": 2545.82, "maximum": 7464.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc face-mm b9+marg 0.5 cm/<", "code_information": [ { "code": "11440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15560.00, "discounted_cash": 9336.00, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc face-mm b9+marg 0.6-1 cm", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15560.00, "discounted_cash": 9336.00, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc face-mm b9+marg 1.1-2 cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1875.75, "discounted_cash": 1125.45, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc benign lesion feenlm 2.1-3", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc face-mm b9+marg 2.1-3 cm", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal sweat gland lesion", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3246.52, "discounted_cash": 1947.91, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal sweat gland lesion", "code_information": [ { "code": "11451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3246.52, "discounted_cash": 1947.91, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc mal lesion tal =<0.5 cm", "code_information": [ { "code": "11600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 443.25, "discounted_cash": 265.95, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 0.5 cm/<", "code_information": [ { "code": "11600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9153.60, "discounted_cash": 5492.16, "minimum": 625.85, "maximum": 1834.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 0.5 cm/<", "code_information": [ { "code": "11600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 443.25, "discounted_cash": 265.95, "minimum": 625.85, "maximum": 1834.94, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 0.6-1 cm", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 625.85, "maximum": 1834.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 1.1-2 cm", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 355.39, "maximum": 1041.96, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc mal lesion tal 2.1-3.0", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 673.25, "discounted_cash": 403.95, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 2.1-3 cm", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 625.85, "maximum": 1834.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 2.1-3 cm", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 673.25, "discounted_cash": 403.95, "minimum": 625.85, "maximum": 1834.94, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc mal lesion tal 3.1-4.0", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 677.25, "discounted_cash": 406.35, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 3.1-4 cm", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 625.85, "maximum": 1834.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg 3.1-4 cm", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 677.25, "discounted_cash": 406.35, "minimum": 625.85, "maximum": 1834.94, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc mal lesion tal >4.0", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1202.75, "discounted_cash": 721.65, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg >4 cm", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext mal+marg >4 cm", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1202.75, "discounted_cash": 721.65, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg 0.5cm<", "code_information": [ { "code": "11640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2943.25, "discounted_cash": 1765.95, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc mal lesion feenl =<0.5", "code_information": [ { "code": "11640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2943.25, "discounted_cash": 1765.95, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg 0.6-1", "code_information": [ { "code": "11641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 568.75, "discounted_cash": 341.25, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc mal lesion feenl 0.6-1.0", "code_information": [ { "code": "11641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 568.75, "discounted_cash": 341.25, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg 1.1-2", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 734.25, "discounted_cash": 440.55, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc mal lesion feenl 1.1-2.0", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 734.25, "discounted_cash": 440.55, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg 3.1-4", "code_information": [ { "code": "11644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 641.50, "discounted_cash": 384.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc malig lesion feenl 3.1-4cm", "code_information": [ { "code": "11644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 641.50, "discounted_cash": 384.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim nail(s) any number", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.50, "discounted_cash": 113.10, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triming nondystrophic nails", "code_information": [ { "code": "11719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.50, "discounted_cash": 113.10, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride nail 1-5", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride nail 6 or more", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride nails >5", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal nail plate", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of nail plate", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal nail plate add'l", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.25, "discounted_cash": 34.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove nail plate add-on", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.25, "discounted_cash": 34.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain blood from nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain blood from under nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of nail bed", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2877.45, "discounted_cash": 1726.47, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nail bed repair", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of nail bed", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of nail fold toe", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wedge resection toenail", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc pilonidal cyst simple", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9111.00, "discounted_cash": 5466.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove pilonidal cyst simple", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9111.00, "discounted_cash": 5466.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc pilonidal cyst extensive", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1341.25, "discounted_cash": 804.75, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1341.25, "discounted_cash": 804.75, "minimum": 2545.82, "maximum": 7464.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc pilonidal cyst complicated", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1983.25, "discounted_cash": 1189.95, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove pilonidal cyst compl", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove pilonidal cyst compl", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1983.25, "discounted_cash": 1189.95, "minimum": 2545.82, "maximum": 7464.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/ax/gen/trnk 2.5cm/<", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 591.75, "10th_percentile": 591.75, "90th_percentile": 591.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 591.75, "10th_percentile": 591.75, "90th_percentile": 591.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 208.94, "10th_percentile": 126.83, "90th_percentile": 214.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 371.23, "10th_percentile": 241.52, "90th_percentile": 486.75, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 543.13, "10th_percentile": 423.94, "90th_percentile": 617.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.88, "10th_percentile": 67.67, "90th_percentile": 70.88, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "1 through 10", "median_amount": 201.79, "10th_percentile": 201.79, "90th_percentile": 201.79, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.91, "10th_percentile": 95.63, "90th_percentile": 188.18, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.96, "10th_percentile": 85.25, "90th_percentile": 150.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.82, "10th_percentile": 27.82, "90th_percentile": 126.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr superficial wnd 2.5cm less", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 591.75, "10th_percentile": 591.75, "90th_percentile": 591.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 591.75, "10th_percentile": 591.75, "90th_percentile": 591.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 208.94, "10th_percentile": 126.83, "90th_percentile": 214.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 371.23, "10th_percentile": 241.52, "90th_percentile": 486.75, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 543.13, "10th_percentile": 423.94, "90th_percentile": 617.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.88, "10th_percentile": 67.67, "90th_percentile": 70.88, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "1 through 10", "median_amount": 201.79, "10th_percentile": 201.79, "90th_percentile": 201.79, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.91, "10th_percentile": 95.63, "90th_percentile": 188.18, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.96, "10th_percentile": 85.25, "90th_percentile": 150.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.82, "10th_percentile": 27.82, "90th_percentile": 126.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/ax/gen/trnk2.6-7.5cm", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 621.45, "10th_percentile": 621.45, "90th_percentile": 621.45, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 621.45, "10th_percentile": 621.45, "90th_percentile": 621.45, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 577.81, "10th_percentile": 572.19, "90th_percentile": 583.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 303.19, "10th_percentile": 303.19, "90th_percentile": 303.19, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 425.71, "10th_percentile": 378.98, "90th_percentile": 532.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.80, "10th_percentile": 29.85, "90th_percentile": 69.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.96, "10th_percentile": 88.22, "90th_percentile": 91.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 605.69, "10th_percentile": 605.69, "90th_percentile": 605.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 605.69, "10th_percentile": 605.69, "90th_percentile": 605.69, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rpr superficial wnd 2.6-7.5 cm", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 621.45, "10th_percentile": 621.45, "90th_percentile": 621.45, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 621.45, "10th_percentile": 621.45, "90th_percentile": 621.45, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 577.81, "10th_percentile": 572.19, "90th_percentile": 583.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 303.19, "10th_percentile": 303.19, "90th_percentile": 303.19, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 425.71, "10th_percentile": 378.98, "90th_percentile": 532.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.80, "10th_percentile": 29.85, "90th_percentile": 69.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.96, "10th_percentile": 88.22, "90th_percentile": 91.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 605.69, "10th_percentile": 605.69, "90th_percentile": 605.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 605.69, "10th_percentile": 605.69, "90th_percentile": 605.69, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rpr s/n/ax/gen/trk7.6-12.5cm", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 93.83, "10th_percentile": 93.83, "90th_percentile": 93.83, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 319.14, "10th_percentile": 319.14, "90th_percentile": 319.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr superficial wnd 7.6-12.5 c", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 93.83, "10th_percentile": 93.83, "90th_percentile": 93.83, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 319.14, "10th_percentile": 319.14, "90th_percentile": 319.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/a/gen/trk12.6-20.0cm", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "1 through 10", "median_amount": 851.45, "10th_percentile": 851.45, "90th_percentile": 851.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr superficial wnd 12.6-20.0c", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "1 through 10", "median_amount": 851.45, "10th_percentile": 851.45, "90th_percentile": 851.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/a/gen/trk20.1-30.0cm", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr superficial wnd 20.1-30cm", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/ax/gen/trnk >30.0 cm", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr superficial wnd >30.0cm", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair simple <2-5cm feenl", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 543.42, "10th_percentile": 479.35, "90th_percentile": 561.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 557.62, "10th_percentile": 540.76, "90th_percentile": 574.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.16, "10th_percentile": 52.35, "90th_percentile": 65.97, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "1 through 10", "median_amount": 211.91, "10th_percentile": 211.91, "90th_percentile": 211.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.06, "10th_percentile": 84.06, "90th_percentile": 84.06, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.08, "10th_percentile": 97.08, "90th_percentile": 97.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 2.5 cm/<", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "1 through 10", "median_amount": 543.42, "10th_percentile": 479.35, "90th_percentile": 561.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 557.62, "10th_percentile": 540.76, "90th_percentile": 574.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.16, "10th_percentile": 52.35, "90th_percentile": 65.97, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "1 through 10", "median_amount": 211.91, "10th_percentile": 211.91, "90th_percentile": 211.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.06, "10th_percentile": 84.06, "90th_percentile": 84.06, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.08, "10th_percentile": 97.08, "90th_percentile": 97.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair simple 2.6-5.0cm feel", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 506.86, "10th_percentile": 410.20, "90th_percentile": 603.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.32, "10th_percentile": 54.44, "90th_percentile": 66.20, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.76, "10th_percentile": 150.76, "90th_percentile": 150.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.82, "10th_percentile": 27.82, "90th_percentile": 27.82, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 2.6-5.0 cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 506.86, "10th_percentile": 410.20, "90th_percentile": 603.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.32, "10th_percentile": 54.44, "90th_percentile": 66.20, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.76, "10th_percentile": 150.76, "90th_percentile": 150.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.82, "10th_percentile": 27.82, "90th_percentile": 27.82, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair simple 5.1-7.5cm feel", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.88, "10th_percentile": 70.88, "90th_percentile": 70.88, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 5.1-7.5 cm", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.88, "10th_percentile": 70.88, "90th_percentile": 70.88, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair simple 7.6-12.5cm feel", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 7.6-12.5 cm", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair simple 12.6-20cm feel", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr fe/e/en/l/m 12.6-20.0 cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair simple 20.1-30cm feel", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr fe/e/en/l/m 20.1-30.0 cm", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair simple >30cm feel", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m >30.0 cm", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closure of split wound", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Simple closure wnd dishiscence", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closure of split wound", "code_information": [ { "code": "12021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx wound dehiscenc sprfl wpack", "code_information": [ { "code": "12021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 2.5 cm/<", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure <2.5cm sat", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 2.6-7.5", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 2.6-7.5cm sat", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/tr/ext 7.6-12.5", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 7.6-12.5cm sat", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 12.6-20", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 12.6-20cm sat", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 20.1-30", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 20.1-30cm sat", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/tr/ext >30.0 cm", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6581.50, "discounted_cash": 3948.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure >30cm sat", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6581.50, "discounted_cash": 3948.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit 2.5cm/<", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure <2.5cm nhfg", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit2.6-7.5", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "1 through 10", "median_amount": 851.45, "10th_percentile": 851.45, "90th_percentile": 851.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "1 through 10", "median_amount": 297.64, "10th_percentile": 297.64, "90th_percentile": 297.64, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 2.6-7.5cm nhfg", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "1 through 10", "median_amount": 851.45, "10th_percentile": 851.45, "90th_percentile": 851.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "1 through 10", "median_amount": 297.64, "10th_percentile": 297.64, "90th_percentile": 297.64, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit7.6-12.5", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr int n/h/f/xtrl gen7.6-12.5", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit12.6-20", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 12.6-20cm nhfg", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit20.1-30", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 20.1-30cm nhfg", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2013.00, "discounted_cash": 1207.80, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit >30.0cm", "code_information": [ { "code": "12047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6581.50, "discounted_cash": 3948.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure >30cm nhfg", "code_information": [ { "code": "12047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6581.50, "discounted_cash": 3948.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 2.5 cm/<", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.47, "10th_percentile": 6.47, "90th_percentile": 6.47, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 2.5-5cm feenl", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.47, "10th_percentile": 6.47, "90th_percentile": 6.47, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 2.6-5.0 cm", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 384.31, "10th_percentile": 384.31, "90th_percentile": 384.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 2.6-5cm feenl", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 384.31, "10th_percentile": 384.31, "90th_percentile": 384.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 5.1-7.5 cm", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 5.1-7.5cm feenl", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 7.6-12.5cm", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 7.6-12.5cm feenl", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 12.6-20 cm", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Layer closure 12.6-20.0cm feen", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1328.25, "discounted_cash": 796.95, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Late closure of wound", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2700.00, "discounted_cash": 1620.00, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sec closure surg wound dehis", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2700.00, "discounted_cash": 1620.00, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tis trnfr trunk 10 sq cm/<", "code_information": [ { "code": "14000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1684.75, "discounted_cash": 1010.85, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue xfer adjacent trunk", "code_information": [ { "code": "14000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1684.75, "discounted_cash": 1010.85, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tis trnfr f/c/c/m/n/a/g/h/f", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4187.20, "discounted_cash": 2512.32, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surg prep trk arm leg 1st 100", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound prep trk/arm/leg", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9153.60, "discounted_cash": 5492.16, "minimum": 1627.12, "maximum": 4770.57, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound prep trk/arm/leg", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound prep addl 100 cm", "code_information": [ { "code": "15003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9153.60, "discounted_cash": 5492.16, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surg prep face hnd ft 1st 100", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1548.25, "discounted_cash": 928.95, "minimum": 544.50, "maximum": 1596.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound prep f/n/hf/g", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9153.60, "discounted_cash": 5492.16, "minimum": 544.50, "maximum": 1596.42, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound prep f/n/hf/g", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1548.25, "discounted_cash": 928.95, "minimum": 544.50, "maximum": 1596.42, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1596.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 544.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wnd prep f/n/hf/g addl cm", "code_information": [ { "code": "15005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9153.60, "discounted_cash": 5492.16, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin splt grft trnk/arm/leg", "code_information": [ { "code": "15100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Splt thick a graft trk arm leg", "code_information": [ { "code": "15100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epidermal a graft tal 1st 100", "code_information": [ { "code": "15110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epidrm autogrft trnk/arm/leg", "code_information": [ { "code": "15110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epider a graft f h ft 1st 100", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epidrm a-grft face/nck/hf/g", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skn splt a-grft fac/nck/hf/g", "code_information": [ { "code": "15120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10408.25, "discounted_cash": 6244.95, "minimum": 3256.47, "maximum": 9547.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3256.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Splt thk agraft f h ft 1st 100", "code_information": [ { "code": "15120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10408.25, "discounted_cash": 6244.95, "minimum": 3256.47, "maximum": 9547.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3256.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App high cost graft leg 1st 25", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft trnk/arm/leg", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App high cost graft leg ea+ 25", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.50, "discounted_cash": 35.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft t/a/l add-on", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.50, "discounted_cash": 35.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App high cst graft leg 1st 100", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10408.25, "discounted_cash": 6244.95, "minimum": 3256.47, "maximum": 9547.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3256.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub grft t/arm/lg child", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10408.25, "discounted_cash": 6244.95, "minimum": 3256.47, "maximum": 9547.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3256.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App high cst graft leg ea+ 100", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.00, "discounted_cash": 91.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skn sub grft t/a/l child add", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.00, "discounted_cash": 91.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App high cst graft feet 1st 25", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft face/nk/hf/g", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App high cst graft feet ea+ 25", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.50, "discounted_cash": 51.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft f/n/hf/g addl", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.50, "discounted_cash": 51.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App high cst graft leg 1st 100", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skn sub grft f/n/hf/g child", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5063.00, "discounted_cash": 3037.80, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "App low cst graft leg ea+100", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1548.25, "discounted_cash": 928.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skn sub grft f/n/hf/g ch add", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1548.25, "discounted_cash": 928.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blepharoplasty upper eyelid", "code_information": [ { "code": "15823", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8100.25, "discounted_cash": 4860.15, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revision of upper eyelid", "code_information": [ { "code": "15823", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8100.25, "discounted_cash": 4860.15, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise excess skin & tissue", "code_information": [ { "code": "15839", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7120.50, "discounted_cash": 4272.30, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise excess skin and tissue", "code_information": [ { "code": "15839", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7120.50, "discounted_cash": 4272.30, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15933", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15936", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove hip pressure sore", "code_information": [ { "code": "15940", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove hip pressure sore", "code_information": [ { "code": "15941", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove hip pressure sore", "code_information": [ { "code": "15944", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 3256.47, "maximum": 9547.70, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9547.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3256.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove hip pressure sore", "code_information": [ { "code": "15945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove hip pressure sore", "code_information": [ { "code": "15946", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9699.83, "discounted_cash": 5819.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of pressure sore", "code_information": [ { "code": "15999", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14161.42, "discounted_cash": 8496.85, "minimum": 625.85, "maximum": 1834.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Initial treatment of burn(s)", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Int tx 1st degree burn", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dress/debrid p-thick burn s", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dsg & or deb pt burns int sml", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.50, "discounted_cash": 414.30, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dress/debrid p-thick burn m", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dsg & or deb pt burns int med", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dress/debrid p-thick burn l", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dsg & or debride pt brn itl lg", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Escharotomy; initial incision", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.75, "discounted_cash": 198.45, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of burn scab initi", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.75, "discounted_cash": 198.45, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destruct b9 lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7774.85, "discounted_cash": 4664.91, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chem caut of granltj tissue", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.25, "discounted_cash": 318.75, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 455.18, "10th_percentile": 455.18, "90th_percentile": 455.18, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 455.18, "10th_percentile": 455.18, "90th_percentile": 455.18, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.52, "10th_percentile": 66.22, "90th_percentile": 150.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of breast lesion", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 978.25, "discounted_cash": 586.95, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy of breast open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35477.90, "discounted_cash": 21286.74, "minimum": 3406.18, "maximum": 9986.64, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy of breast open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16259.30, "discounted_cash": 9755.58, "minimum": 3406.18, "maximum": 9986.64, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy of breast open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16259.30, "discounted_cash": 9755.58, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1483.86, "10th_percentile": 1483.86, "90th_percentile": 1483.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9417.25, "discounted_cash": 5650.35, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9417.25, "discounted_cash": 5650.35, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2761.39, "10th_percentile": 2761.39, "90th_percentile": 2761.39, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial mastectomy", "code_information": [ { "code": "19301", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1580.00, "discounted_cash": 948.00, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Explore wound chest", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 701.50, "discounted_cash": 420.90, "minimum": 1627.12, "maximum": 4770.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4770.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1627.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Explore wound extremity", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2943.25, "discounted_cash": 1765.95, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise epiphyseal bar", "code_information": [ { "code": "20150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy muscle deep", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 359.50, "discounted_cash": 215.70, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deep muscle biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 359.50, "discounted_cash": 215.70, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle biopsy muscle", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8009.20, "discounted_cash": 4805.52, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle biopsy muscle", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8009.20, "discounted_cash": 4805.52, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy bone superficial ndl", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4159.25, "discounted_cash": 2495.55, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone biopsy trocar/needle", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4159.25, "discounted_cash": 2495.55, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy bone deep ndl", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4159.25, "discounted_cash": 2495.55, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone biopsy trocar/needle", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4159.25, "discounted_cash": 2495.55, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8410.00, "discounted_cash": 5046.00, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foreign body", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 517.50, "discounted_cash": 310.50, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove fb muscle tendon sheath", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 517.50, "discounted_cash": 310.50, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel tx inj", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther injection carp tunnel", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel tx inj bilateral", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2471.50, "discounted_cash": 1482.90, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj sgl tendon shth/ligament", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj tendon sheath/ligament", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj tendon origin/insertion", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 262.57, "maximum": 769.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj tendon origin/insertion", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injection tendon single", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj trigger point 1/2 muscl", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4998.25, "discounted_cash": 2998.95, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.91, "10th_percentile": 110.73, "90th_percentile": 125.08, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj trigger point 1/2 muscl", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4998.25, "discounted_cash": 2998.95, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj trigger point 1/2 muscl", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1673.25, "discounted_cash": 1003.95, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "1 through 10", "median_amount": 61.22, "10th_percentile": 61.22, "90th_percentile": 61.22, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject trigger points 3/>", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1985.75, "discounted_cash": 1191.45, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ndl insj w/o njx 1 or 2 musc", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.50, "discounted_cash": 61.50, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ndl insert wo inj 1-2 muscle", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.50, "discounted_cash": 61.50, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ndl insj w/o njx 3+ musc", "code_information": [ { "code": "20561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.50, "discounted_cash": 61.50, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ndl insertion wo inj 3+mus", "code_information": [ { "code": "20561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.50, "discounted_cash": 61.50, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspiration inj sml jnt bursa", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 262.57, "maximum": 769.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 262.57, "maximum": 769.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspiration inj interm jnt burs", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 262.57, "maximum": 769.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 616.00, "maximum": 1806.07, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 262.57, "maximum": 769.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "1 through 10", "median_amount": 443.05, "10th_percentile": 443.05, "90th_percentile": 443.05, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 186.20, "10th_percentile": 186.20, "90th_percentile": 186.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 93.22, "10th_percentile": 33.39, "90th_percentile": 128.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "1 through 10", "median_amount": 190.12, "10th_percentile": 190.12, "90th_percentile": 190.12, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.70, "10th_percentile": 71.70, "90th_percentile": 89.62, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4301.52, "discounted_cash": 2580.91, "minimum": 262.57, "maximum": 769.85, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "1 through 10", "median_amount": 443.05, "10th_percentile": 443.05, "90th_percentile": 443.05, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 186.20, "10th_percentile": 186.20, "90th_percentile": 186.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 93.22, "10th_percentile": 33.39, "90th_percentile": 128.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "1 through 10", "median_amount": 190.12, "10th_percentile": 190.12, "90th_percentile": 190.12, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.70, "10th_percentile": 71.70, "90th_percentile": 89.62, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4301.52, "discounted_cash": 2580.91, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "1 through 10", "median_amount": 482.14, "10th_percentile": 391.34, "90th_percentile": 1144.38, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 552.26, "10th_percentile": 341.83, "90th_percentile": 1380.26, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 60.71, "10th_percentile": 60.71, "90th_percentile": 66.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "1 through 10", "median_amount": 181.07, "10th_percentile": 181.07, "90th_percentile": 527.53, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 192.05, "10th_percentile": 192.05, "90th_percentile": 382.05, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.57, "10th_percentile": 150.57, "90th_percentile": 200.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 456.54, "10th_percentile": 456.54, "90th_percentile": 456.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 456.54, "10th_percentile": 456.54, "90th_percentile": 456.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 160.48, "10th_percentile": 105.32, "90th_percentile": 168.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3239.01, "discounted_cash": 1943.41, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 339.12, "10th_percentile": 339.12, "90th_percentile": 339.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "1 through 10", "median_amount": 208.50, "10th_percentile": 198.54, "90th_percentile": 255.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 287.84, "10th_percentile": 62.10, "90th_percentile": 538.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.36, "10th_percentile": 22.90, "90th_percentile": 31.80, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.29, "10th_percentile": 75.29, "90th_percentile": 199.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.22, "10th_percentile": 70.21, "90th_percentile": 97.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 285.34, "10th_percentile": 285.34, "90th_percentile": 285.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 285.34, "10th_percentile": 285.34, "90th_percentile": 285.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2921.61, "discounted_cash": 1752.97, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 380.17, "10th_percentile": 367.33, "90th_percentile": 382.56, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "1 through 10", "median_amount": 254.40, "10th_percentile": 249.42, "90th_percentile": 259.38, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.27, "10th_percentile": 65.24, "90th_percentile": 474.92, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 31.08, "10th_percentile": 30.36, "90th_percentile": 31.80, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.02, "10th_percentile": 96.02, "90th_percentile": 96.02, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.87, "10th_percentile": 56.46, "90th_percentile": 146.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 84.26, "10th_percentile": 74.37, "90th_percentile": 84.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 262.57, "maximum": 769.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 509.60, "10th_percentile": 509.60, "90th_percentile": 509.60, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3591.87, "discounted_cash": 2155.12, "minimum": 262.57, "maximum": 769.85, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 509.60, "10th_percentile": 509.60, "90th_percentile": 509.60, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3591.87, "discounted_cash": 2155.12, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirate/inj ganglion cyst", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 945.00, "discounted_cash": 567.00, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain inj small jnt bursa", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.75, "discounted_cash": 88.05, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of support implant", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.75, "discounted_cash": 88.05, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of support implant", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29259.21, "discounted_cash": 17555.53, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5952.06, "10th_percentile": 5952.06, "90th_percentile": 5952.06, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of support implant", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29259.21, "discounted_cash": 17555.53, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of support implant", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17075.73, "discounted_cash": 10245.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of bone for graft", "code_information": [ { "code": "20900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of bone for graft", "code_information": [ { "code": "20902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluid pressure muscle", "code_information": [ { "code": "20950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 716.75, "discounted_cash": 430.05, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Monitoring of interstitial fld", "code_information": [ { "code": "20950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 716.75, "discounted_cash": 430.05, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Other bone graft microvasc", "code_information": [ { "code": "20962", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone/skin graft great toe", "code_information": [ { "code": "20973", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cptr-asst dir ms px", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76844.33, "discounted_cash": 46106.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cptr-asst dir ms px", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75100.52, "discounted_cash": 45060.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cptr-asst dir ms px", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78545.53, "discounted_cash": 47127.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain neck chest lesion", "code_information": [ { "code": "21501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9111.00, "discounted_cash": 5466.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain neck/chest lesion", "code_information": [ { "code": "21501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9111.00, "discounted_cash": 5466.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc neck les sc 3 cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11213.50, "discounted_cash": 6728.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc neck lesion sq 3cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11213.50, "discounted_cash": 6728.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc neck tum deep 5 cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 852.75, "discounted_cash": 511.65, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exe neck tumor deep 5 cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 852.75, "discounted_cash": 511.65, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc back les sc 3 cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1416.75, "discounted_cash": 850.05, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc back lesion sc 3cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1416.75, "discounted_cash": 850.05, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incis w/discectomy lumbar", "code_information": [ { "code": "22224", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7301.50, "discounted_cash": 4380.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Osteotomy spine one sgm lumbar", "code_information": [ { "code": "22224", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7301.50, "discounted_cash": 4380.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perq cervicothoracic inj", "code_information": [ { "code": "22510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perq cervicothoracic inject", "code_information": [ { "code": "22510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perq lumbosacral injection", "code_information": [ { "code": "22511", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perq vertebral augmentation", "code_information": [ { "code": "22513", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 67376.86, "discounted_cash": 40426.12, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5399.50, "10th_percentile": 5399.50, "90th_percentile": 5399.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perq vertebral augmentation", "code_information": [ { "code": "22514", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55208.10, "discounted_cash": 33124.86, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26534.31, "10th_percentile": 26534.31, "90th_percentile": 26534.31, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3193.25, "10th_percentile": 3193.25, "90th_percentile": 3193.25, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perq vertebral augmentation", "code_information": [ { "code": "22515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74377.05, "discounted_cash": 44626.23, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2156.15, "10th_percentile": 2156.15, "90th_percentile": 2156.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lumbar spine fusion", "code_information": [ { "code": "22612", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 16358.12, "maximum": 47960.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16358.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert spine fixation device", "code_information": [ { "code": "22840", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3563.75, "discounted_cash": 2138.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert stable device lumb sing", "code_information": [ { "code": "22869", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insj stablj dev w/o dcmprn", "code_information": [ { "code": "22869", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert stable device lum 2nd l", "code_information": [ { "code": "22870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 548.00, "discounted_cash": 328.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insj stablj dev w/o dcmprn", "code_information": [ { "code": "22870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 548.00, "discounted_cash": 328.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc abdl tum deep 5 cm/>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2216.00, "discounted_cash": 1329.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc abdl tum deep 5cm/>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2216.00, "discounted_cash": 1329.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc abd les sc < 3 cm", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1089.75, "discounted_cash": 653.85, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc abd les sc <3cm", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1089.75, "discounted_cash": 653.85, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc abd les sc 3 cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1263.50, "discounted_cash": 758.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 665.22, "10th_percentile": 665.22, "90th_percentile": 665.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc abd les sc 3cm>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1263.50, "discounted_cash": 758.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 665.22, "10th_percentile": 665.22, "90th_percentile": 665.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release shoulder joint", "code_information": [ { "code": "23020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46380.13, "discounted_cash": 27828.08, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release shoulder joint", "code_information": [ { "code": "23020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46380.13, "discounted_cash": 27828.08, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "1 through 10", "median_amount": 920.70, "10th_percentile": 920.70, "90th_percentile": 920.70, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy shoulder tissues", "code_information": [ { "code": "23066", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 231.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy soft tissue shldr deep", "code_information": [ { "code": "23066", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 231.60, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc shoulder tum deep < 5 cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11213.50, "discounted_cash": 6728.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc shoulder tum deep<5 cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11213.50, "discounted_cash": 6728.10, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Claviculectomy partial", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal collar bone", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove shoulder bone part", "code_information": [ { "code": "23130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2756.25, "discounted_cash": 1653.75, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of tendon & muscle", "code_information": [ { "code": "23405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62055.05, "discounted_cash": 37233.03, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of tendon & muscle", "code_information": [ { "code": "23405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62055.05, "discounted_cash": 37233.03, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair rotator cuff acute", "code_information": [ { "code": "23410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64675.15, "discounted_cash": 38805.09, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 122.49, "10th_percentile": 122.49, "90th_percentile": 122.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair rotator cuff acute", "code_information": [ { "code": "23410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64675.15, "discounted_cash": 38805.09, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair rotator cuff chronic", "code_information": [ { "code": "23412", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50861.65, "discounted_cash": 30516.99, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair rotator cuff chronic", "code_information": [ { "code": "23412", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61098.88, "discounted_cash": 36659.33, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7578.87, "10th_percentile": 7578.87, "90th_percentile": 7578.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair rotator cuff chronic", "code_information": [ { "code": "23412", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 52053.74, "discounted_cash": 31232.24, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release of shoulder ligament", "code_information": [ { "code": "23415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24723.09, "discounted_cash": 14833.85, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release of shoulder ligament", "code_information": [ { "code": "23415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24723.09, "discounted_cash": 14833.85, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "1 through 10", "median_amount": 11729.26, "10th_percentile": 11729.26, "90th_percentile": 11729.26, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair biceps tendon", "code_information": [ { "code": "23430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53445.07, "discounted_cash": 32067.04, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair biceps tendon", "code_information": [ { "code": "23430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57147.72, "discounted_cash": 34288.63, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4430.62, "10th_percentile": 4430.62, "90th_percentile": 4430.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reconstruct shoulder joint", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46039.78, "discounted_cash": 27623.87, "minimum": 16358.12, "maximum": 47960.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16358.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reconstruct shoulder joint", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44780.04, "discounted_cash": 26868.02, "minimum": 16358.12, "maximum": 47960.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16358.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reconstruct shoulder joint", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46039.78, "discounted_cash": 27623.87, "minimum": 16358.12, "maximum": 47960.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16358.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2392.24, "10th_percentile": 2392.24, "90th_percentile": 2392.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle dislocation", "code_information": [ { "code": "23532", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14161.42, "discounted_cash": 8496.85, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle dislocation", "code_information": [ { "code": "23552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14161.42, "discounted_cash": 8496.85, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closed tx shoulder dislocation", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 804.50, "discounted_cash": 482.70, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "1 through 10", "median_amount": 634.80, "10th_percentile": 634.80, "90th_percentile": 634.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 690.41, "10th_percentile": 690.41, "90th_percentile": 690.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.42, "10th_percentile": 64.65, "90th_percentile": 270.20, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat shoulder dislocation", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 804.50, "discounted_cash": 482.70, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "1 through 10", "median_amount": 634.80, "10th_percentile": 634.80, "90th_percentile": 634.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 690.41, "10th_percentile": 690.41, "90th_percentile": 690.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.42, "10th_percentile": 64.65, "90th_percentile": 270.20, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dislocation shoulder man&anest", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5600.75, "discounted_cash": 3360.45, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat shoulder dislocation", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5600.75, "discounted_cash": 3360.45, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fixation of shoulder", "code_information": [ { "code": "23700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Manip shldr joint under anesth", "code_information": [ { "code": "23700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of arm lesion", "code_information": [ { "code": "23930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 762.00, "discounted_cash": 457.20, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d upper arm elbow deep", "code_information": [ { "code": "23930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 762.00, "discounted_cash": 457.20, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy arm/elbow soft tissue", "code_information": [ { "code": "24065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19102.08, "discounted_cash": 11461.25, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy arm/elbow soft tissue", "code_information": [ { "code": "24065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19102.08, "discounted_cash": 11461.25, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2757.60, "10th_percentile": 2757.60, "90th_percentile": 2757.60, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc arm/elbow les sc 3 cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11318.01, "discounted_cash": 6790.81, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc arm/elbow les sc 3 cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11318.01, "discounted_cash": 6790.81, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "1 through 10", "median_amount": 1725.85, "10th_percentile": 1725.85, "90th_percentile": 1725.85, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc arm/elb lesion <3cm", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5209.50, "discounted_cash": 3125.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc arm/elbow les sc < 3 cm", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5209.50, "discounted_cash": 3125.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of elbow bursa", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18451.70, "discounted_cash": 11071.02, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of elbow bursa", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18451.70, "discounted_cash": 11071.02, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of biceps tendon", "code_information": [ { "code": "24340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22545.25, "discounted_cash": 13527.15, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tenedesis biceps tdn at elbow", "code_information": [ { "code": "24340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22545.25, "discounted_cash": 13527.15, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair arm tendon/muscle", "code_information": [ { "code": "24341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39998.60, "discounted_cash": 23999.16, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair arm tendon/muscle", "code_information": [ { "code": "24341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39998.60, "discounted_cash": 23999.16, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair elbow w/deb open", "code_information": [ { "code": "24358", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17700.45, "discounted_cash": 10620.27, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair elbow w/deb open", "code_information": [ { "code": "24358", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17700.45, "discounted_cash": 10620.27, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair elbow deb attch open", "code_information": [ { "code": "24359", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair elbow deb/attch open", "code_information": [ { "code": "24359", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2400.00, "discounted_cash": 1440.00, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat elbow dislocation", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1141.00, "discounted_cash": 684.60, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx closed elbow disl wo anes", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1141.00, "discounted_cash": 684.60, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat elbow dislocation", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.25, "discounted_cash": 475.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx elbow dislocation", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.25, "discounted_cash": 475.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat radius fracture", "code_information": [ { "code": "24655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3561.75, "discounted_cash": 2137.05, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Close tx ulnar fx proximal end", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 603.25, "discounted_cash": 361.95, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ulnar fracture", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 603.25, "discounted_cash": 361.95, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Open tx ulnar fx proximal end", "code_information": [ { "code": "24685", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ulnar fracture", "code_information": [ { "code": "24685", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inc ext tendon sheath wrist", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of tendon sheath", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove wrist tendon lesion", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12814.15, "discounted_cash": 7688.49, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 645.56, "10th_percentile": 645.56, "90th_percentile": 645.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove wrist tendon lesion", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12814.15, "discounted_cash": 7688.49, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of ulna", "code_information": [ { "code": "25119", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1884.75, "discounted_cash": 1130.85, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpectomy; all bones prox row", "code_information": [ { "code": "25215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of wrist bones", "code_information": [ { "code": "25215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fusion of tendon at wrist", "code_information": [ { "code": "25301", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10045.00, "discounted_cash": 6027.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fusion of tendons at wrist", "code_information": [ { "code": "25301", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10045.00, "discounted_cash": 6027.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair wrist joints", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23972.96, "discounted_cash": 14383.78, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1375.02, "10th_percentile": 1375.02, "90th_percentile": 1375.02, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair wrist joints", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22273.48, "discounted_cash": 13364.09, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3707.66, "10th_percentile": 3707.66, "90th_percentile": 3707.66, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthrp ntrcrpl/crp/mtcrp ssp", "code_information": [ { "code": "25448", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16526.70, "discounted_cash": 9916.02, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthrp ntrcrpl/crp/mtcrp ssp", "code_information": [ { "code": "25448", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16526.70, "discounted_cash": 9916.02, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of radius", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3954.25, "discounted_cash": 2372.55, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fx of radius", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3954.25, "discounted_cash": 2372.55, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fx ulnar shaft clsd tx wo man", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.25, "discounted_cash": 475.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of ulna", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.25, "discounted_cash": 475.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fx care w man ulnar shaft", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1132.50, "discounted_cash": 679.50, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of ulna", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1132.50, "discounted_cash": 679.50, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of ulna", "code_information": [ { "code": "25545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18230.00, "discounted_cash": 10938.00, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fx ulna", "code_information": [ { "code": "25545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18230.00, "discounted_cash": 10938.00, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cl tx radial & ulna fx w man", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4220.50, "discounted_cash": 2532.30, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "1 through 10", "median_amount": 3306.91, "10th_percentile": 3306.91, "90th_percentile": 3306.91, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius & ulna", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4220.50, "discounted_cash": 2532.30, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "1 through 10", "median_amount": 3306.91, "10th_percentile": 3306.91, "90th_percentile": 3306.91, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius/ulna", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13261.26, "discounted_cash": 7956.76, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1659.20, "10th_percentile": 1659.20, "90th_percentile": 1659.20, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3566.80, "10th_percentile": 3400.46, "90th_percentile": 3733.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius/ulna", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10178.09, "discounted_cash": 6106.85, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius/ulna", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13261.26, "discounted_cash": 7956.76, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fx distal radial", "code_information": [ { "code": "25606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fx rad extra-articul", "code_information": [ { "code": "25607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Txx fx radial ex articular fx", "code_information": [ { "code": "25607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fx radial 3+ frag", "code_information": [ { "code": "25609", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19141.50, "discounted_cash": 11484.90, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cl tx radiocarpal 1+ bones w m", "code_information": [ { "code": "25660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1492.75, "discounted_cash": 895.65, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist dislocation", "code_information": [ { "code": "25660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1492.75, "discounted_cash": 895.65, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain finger abscess simple", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 627.50, "discounted_cash": 376.50, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of finger abscess", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 627.50, "discounted_cash": 376.50, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release palm contracture", "code_information": [ { "code": "26045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16108.78, "discounted_cash": 9665.27, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release palm contracture", "code_information": [ { "code": "26045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16108.78, "discounted_cash": 9665.27, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incise finger tendon sheath", "code_information": [ { "code": "26055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15282.27, "discounted_cash": 9169.36, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc hand les sc < 1.5 cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4209.00, "discounted_cash": 2525.40, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc hand les sc < 1.5 cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4209.00, "discounted_cash": 2525.40, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 478.60, "10th_percentile": 478.60, "90th_percentile": 478.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release palm contracture", "code_information": [ { "code": "26123", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12479.41, "discounted_cash": 7487.65, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release palm contracture", "code_information": [ { "code": "26123", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13724.28, "discounted_cash": 8234.57, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release palm contracture", "code_information": [ { "code": "26125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11234.54, "discounted_cash": 6740.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 350.35, "10th_percentile": 350.35, "90th_percentile": 350.35, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove tendon sheath lesion", "code_information": [ { "code": "26160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11017.38, "discounted_cash": 6610.43, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision tumor phalanx finger", "code_information": [ { "code": "26210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of finger lesion", "code_information": [ { "code": "26210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair hand tendon", "code_information": [ { "code": "26410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8269.70, "discounted_cash": 4961.82, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair hand tendon", "code_information": [ { "code": "26410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8269.70, "discounted_cash": 4961.82, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise/implant finger joint", "code_information": [ { "code": "26536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12137.70, "discounted_cash": 7282.62, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 957.25, "discounted_cash": 574.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx metacarpal fracture", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 957.25, "discounted_cash": 574.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closed tx metacarpal fx", "code_information": [ { "code": "26607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perc sk fixation mc fx; ea bon", "code_information": [ { "code": "26608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8785.49, "discounted_cash": 5271.29, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1525.00, "discounted_cash": 915.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fx ea", "code_information": [ { "code": "26727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1525.00, "discounted_cash": 915.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cltx dst phgl fx fgr/thb wo mn", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 731.50, "discounted_cash": 438.90, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 731.50, "discounted_cash": 438.90, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fx distal phalangeal w man", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 629.50, "discounted_cash": 377.70, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.15, "10th_percentile": 70.15, "90th_percentile": 70.15, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 629.50, "discounted_cash": 377.70, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.15, "10th_percentile": 70.15, "90th_percentile": 70.15, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Percutaneous skeletal fixation", "code_information": [ { "code": "26756", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10473.75, "discounted_cash": 6284.25, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pin finger fracture each", "code_information": [ { "code": "26756", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10473.75, "discounted_cash": 6284.25, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dislocation i-p joint", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 873.75, "discounted_cash": 524.25, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger dislocation", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 873.75, "discounted_cash": 524.25, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputate metacarpal bone", "code_information": [ { "code": "26910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13583.28, "discounted_cash": 8149.97, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputate fing/th sgl w dir clo", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation of finger/thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of pelvis lesion", "code_information": [ { "code": "26990", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75637.98, "discounted_cash": 45382.79, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove femur lesion", "code_information": [ { "code": "27062", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10335.50, "discounted_cash": 6201.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove femur lesion/bursa", "code_information": [ { "code": "27062", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10335.50, "discounted_cash": 6201.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4053.25, "discounted_cash": 2431.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 346.71, "10th_percentile": 321.50, "90th_percentile": 346.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4220.44, "discounted_cash": 2532.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3787.69, "discounted_cash": 2272.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 785.70, "10th_percentile": 758.05, "90th_percentile": 813.35, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.89, "10th_percentile": 65.89, "90th_percentile": 65.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 781.68, "10th_percentile": 781.68, "90th_percentile": 781.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3863.51, "discounted_cash": 2318.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 719.47, "10th_percentile": 719.47, "90th_percentile": 719.47, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.89, "10th_percentile": 65.89, "90th_percentile": 65.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemiarthroplasy partial hip", "code_information": [ { "code": "27125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15986.25, "discounted_cash": 9591.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial hip replacement", "code_information": [ { "code": "27125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15986.25, "discounted_cash": 9591.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93328.69, "discounted_cash": 55997.21, "minimum": 11445.15, "maximum": 33556.26, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1054.35, "10th_percentile": 325.57, "90th_percentile": 3639.72, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101844.88, "discounted_cash": 61106.93, "minimum": 11445.15, "maximum": 33556.26, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1054.35, "10th_percentile": 325.57, "90th_percentile": 3639.72, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 99318.63, "discounted_cash": 59591.18, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "1 through 10", "median_amount": 36797.79, "10th_percentile": 36797.79, "90th_percentile": 36797.79, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10123.23, "10th_percentile": 10123.23, "90th_percentile": 10123.23, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104738.38, "discounted_cash": 62843.03, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "1 through 10", "median_amount": 32542.14, "10th_percentile": 32542.14, "90th_percentile": 32542.14, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93328.69, "discounted_cash": 55997.21, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise hip joint replacement", "code_information": [ { "code": "27134", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93328.69, "discounted_cash": 55997.21, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reduce traumatic hip wo anesth", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.75, "discounted_cash": 285.45, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.75, "discounted_cash": 285.45, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closed tx post hip arthroplast", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1436.25, "discounted_cash": 861.75, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1436.25, "discounted_cash": 861.75, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthrodesis sacroiliac joint", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 121948.46, "discounted_cash": 73169.08, "minimum": 16358.12, "maximum": 47960.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47960.68, "count": "1 through 10", "median_amount": 61272.61, "10th_percentile": 61272.61, "90th_percentile": 61272.61, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16358.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthrodesis sacroiliac joint", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126113.72, "discounted_cash": 75668.23, "minimum": 16358.12, "maximum": 47960.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47960.68, "count": "1 through 10", "median_amount": 63635.09, "10th_percentile": 63635.09, "90th_percentile": 63635.09, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16358.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthrodesis sacroiliac joint", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124426.82, "discounted_cash": 74656.09, "minimum": 16358.12, "maximum": 47960.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47960.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16358.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fusion of sacroiliac joint", "code_information": [ { "code": "27280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89380.59, "discounted_cash": 53628.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fusion of sacroiliac joint", "code_information": [ { "code": "27280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89380.59, "discounted_cash": 53628.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14582.56, "10th_percentile": 14582.56, "90th_percentile": 14582.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pelvis/hip joint surgery", "code_information": [ { "code": "27299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5826.75, "discounted_cash": 3496.05, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Unlisted proc pelvis/hip jnt", "code_information": [ { "code": "27299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5826.75, "discounted_cash": 3496.05, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy thigh soft tissues", "code_information": [ { "code": "27323", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19102.08, "discounted_cash": 11461.25, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy thigh soft tissues", "code_information": [ { "code": "27323", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19102.08, "discounted_cash": 11461.25, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee les sc < 3 cm", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee les sc < 3 cm", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11568.58, "discounted_cash": 6941.15, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee les sc < 3 cm", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11568.58, "discounted_cash": 6941.15, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee tum deep <5cm", "code_information": [ { "code": "27328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthromy rmv knee cartlidge", "code_information": [ { "code": "27333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9846.75, "discounted_cash": 5908.05, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of knee cartilage", "code_information": [ { "code": "27333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9846.75, "discounted_cash": 5908.05, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthrotomy w synov knee a&p", "code_information": [ { "code": "27334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove knee joint lining", "code_information": [ { "code": "27334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee les sc 3 cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee les sc 3 cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1679.75, "discounted_cash": 1007.85, "minimum": 2545.82, "maximum": 7464.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee tum dep 5cm/>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision prepatellar bursa", "code_information": [ { "code": "27340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of kneecap bursa", "code_information": [ { "code": "27340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision lesion meniscus/cpsl", "code_information": [ { "code": "27347", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3307.50, "discounted_cash": 1984.50, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove knee cyst", "code_information": [ { "code": "27347", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3307.50, "discounted_cash": 1984.50, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect thigh/knee tum 5 cm/>", "code_information": [ { "code": "27364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal fb deep thigh knee", "code_information": [ { "code": "27372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4073.00, "discounted_cash": 2443.80, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foreign body", "code_information": [ { "code": "27372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75637.98, "discounted_cash": 45382.79, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foreign body", "code_information": [ { "code": "27372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4073.00, "discounted_cash": 2443.80, "minimum": 2545.82, "maximum": 7464.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of kneecap tendon", "code_information": [ { "code": "27380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55944.91, "discounted_cash": 33566.95, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of kneecap tendon", "code_information": [ { "code": "27380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55944.91, "discounted_cash": 33566.95, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lengthening of thigh tendon", "code_information": [ { "code": "27393", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55359.94, "discounted_cash": 33215.96, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lengthening of thigh tendon", "code_information": [ { "code": "27393", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55359.94, "discounted_cash": 33215.96, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lat retinacular release open", "code_information": [ { "code": "27425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy knee medial/lat", "code_information": [ { "code": "27446", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revision of knee joint", "code_information": [ { "code": "27446", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62709.82, "discounted_cash": 37625.89, "minimum": 11445.15, "maximum": 33556.26, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3630.31, "10th_percentile": 779.15, "90th_percentile": 3803.18, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78833.08, "discounted_cash": 47299.85, "minimum": 11445.15, "maximum": 33556.26, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3630.31, "10th_percentile": 779.15, "90th_percentile": 3803.18, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77624.15, "discounted_cash": 46574.49, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "1 through 10", "median_amount": 29683.75, "10th_percentile": 29683.75, "90th_percentile": 29683.75, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18102.56, "10th_percentile": 4501.34, "90th_percentile": 20134.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "1 through 10", "median_amount": 5684.40, "10th_percentile": 5684.40, "90th_percentile": 5684.40, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4352.37, "10th_percentile": 3571.43, "90th_percentile": 5133.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81462.64, "discounted_cash": 48877.58, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18053.56, "10th_percentile": 18053.56, "90th_percentile": 18053.56, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3572.69, "10th_percentile": 3001.07, "90th_percentile": 4144.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5476.41, "10th_percentile": 5059.46, "90th_percentile": 5893.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise/replace knee joint", "code_information": [ { "code": "27486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36045.37, "discounted_cash": 21627.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise/replace knee joint", "code_information": [ { "code": "27486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36045.37, "discounted_cash": 21627.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rev total knee arthroplasty", "code_information": [ { "code": "27487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8049.25, "discounted_cash": 4829.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise/replace knee joint", "code_information": [ { "code": "27487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62709.82, "discounted_cash": 37625.89, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise/replace knee joint", "code_information": [ { "code": "27487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8049.25, "discounted_cash": 4829.55, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closed tx fem fx distal end", "code_information": [ { "code": "27510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7166.25, "discounted_cash": 4299.75, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7166.25, "discounted_cash": 4299.75, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat kneecap fracture", "code_information": [ { "code": "27524", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19141.50, "discounted_cash": 11484.90, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cl tx patellar disloc w anesth", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1034.00, "discounted_cash": 620.40, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat kneecap dislocation", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1034.00, "discounted_cash": 620.40, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fixation of knee joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Manipulate knee jnt under anes", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain lower leg lesion", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14702.89, "discounted_cash": 8821.73, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of achilles tendon", "code_information": [ { "code": "27605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1653.75, "discounted_cash": 992.25, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tenot percut achilles tendon", "code_information": [ { "code": "27605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1653.75, "discounted_cash": 992.25, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect leg/ankle tum < 5 cm", "code_information": [ { "code": "27615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect leg/ankle tum 5 cm/>", "code_information": [ { "code": "27616", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc leg/ankle tum < 3 cm", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc leg/ankle tum deep <5 cm", "code_information": [ { "code": "27619", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Explore tx ankle joint", "code_information": [ { "code": "27620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Explore/treat ankle joint", "code_information": [ { "code": "27620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of tendon lesion", "code_information": [ { "code": "27630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8204.50, "discounted_cash": 4922.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal tendon lesion", "code_information": [ { "code": "27630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8204.50, "discounted_cash": 4922.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc leg/ankle les sc 3 cm/>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc leg/ankle les sc 3 cm/>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12530.09, "discounted_cash": 7518.05, "minimum": 2545.82, "maximum": 7464.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc leg/ankle les sc 3 cm/>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12530.09, "discounted_cash": 7518.05, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc leg/ankle tum dep 5 cm/>", "code_information": [ { "code": "27634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair achilles tendon", "code_information": [ { "code": "27650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30931.18, "discounted_cash": 18558.71, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair achilles tendon", "code_information": [ { "code": "27650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30931.18, "discounted_cash": 18558.71, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "1 through 10", "median_amount": 6518.32, "10th_percentile": 6518.32, "90th_percentile": 6518.32, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair/graft achilles tendon", "code_information": [ { "code": "27652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38555.22, "discounted_cash": 23133.13, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair/graft achilles tendon", "code_information": [ { "code": "27652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38555.22, "discounted_cash": 23133.13, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of achilles tendon", "code_information": [ { "code": "27654", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29210.60, "discounted_cash": 17526.36, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of achilles tendon", "code_information": [ { "code": "27654", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29210.60, "discounted_cash": 17526.36, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of leg tendon each", "code_information": [ { "code": "27664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15908.20, "discounted_cash": 9544.92, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of leg tendon each", "code_information": [ { "code": "27664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15908.20, "discounted_cash": 9544.92, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise lower leg tendon", "code_information": [ { "code": "27691", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45272.70, "discounted_cash": 27163.62, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise lower leg tendon", "code_information": [ { "code": "27691", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45272.70, "discounted_cash": 27163.62, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cltx med ankle fx w/mnpj", "code_information": [ { "code": "27762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6587.25, "discounted_cash": 3952.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Open tx medial malleolus fx", "code_information": [ { "code": "27766", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Optx medial ankle fx", "code_information": [ { "code": "27766", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cltx fibular fx w manip", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.00, "discounted_cash": 774.60, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.00, "discounted_cash": 774.60, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Open tx distal fibular fx", "code_information": [ { "code": "27792", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27792", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cltx bimalleolar ankle fxt w m", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5352.25, "discounted_cash": 3211.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5352.25, "discounted_cash": 3211.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Open tx bimalleolar ankle fx", "code_information": [ { "code": "27814", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27814", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clsd tx ankle fx w manip", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1249.25, "discounted_cash": 749.55, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1249.25, "discounted_cash": 749.55, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg fracture", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3954.25, "discounted_cash": 2372.55, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg fx", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3954.25, "discounted_cash": 2372.55, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Open tx fracture distal tibia", "code_information": [ { "code": "27828", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg fracture", "code_information": [ { "code": "27828", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58313.75, "discounted_cash": 34988.25, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg joint", "code_information": [ { "code": "27829", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3867.25, "discounted_cash": 2320.35, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation of lower leg", "code_information": [ { "code": "27880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12650.75, "discounted_cash": 7590.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of bursa of foot", "code_information": [ { "code": "28001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4159.25, "discounted_cash": 2495.55, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Level 3 i&d bursa foot", "code_information": [ { "code": "28001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4159.25, "discounted_cash": 2495.55, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of toe tendon", "code_information": [ { "code": "28010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4117.25, "discounted_cash": 2470.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tenotomy toe single", "code_information": [ { "code": "28010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4117.25, "discounted_cash": 2470.35, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot/toe tum sc 1.5 cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot/toe tum sc 1.5 cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10832.38, "discounted_cash": 6499.43, "minimum": 2545.82, "maximum": 7464.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot/toe tum sc 1.5 cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10832.38, "discounted_cash": 6499.43, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1737.99, "10th_percentile": 1737.99, "90th_percentile": 1737.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot/toe tum dep 1.5cm/>", "code_information": [ { "code": "28041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25669.49, "discounted_cash": 15401.69, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot/toe tum dep 1.5cm/>", "code_information": [ { "code": "28041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25669.49, "discounted_cash": 15401.69, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "1 through 10", "median_amount": 1317.52, "10th_percentile": 1317.52, "90th_percentile": 1317.52, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot toe st tumer <1.5 cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot/toe tum sc < 1.5 cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc foot/toe tum sc < 1.5 cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect foot/toe tumor < 3 cm", "code_information": [ { "code": "28046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17631.55, "discounted_cash": 10578.93, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect foot/toe tumor 3 cm/>", "code_information": [ { "code": "28047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17631.55, "discounted_cash": 10578.93, "minimum": 2545.82, "maximum": 7464.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal foot fascia", "code_information": [ { "code": "28060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot fascia", "code_information": [ { "code": "28062", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot lesion", "code_information": [ { "code": "28080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6135.74, "discounted_cash": 3681.44, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot lesion", "code_information": [ { "code": "28080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5150.51, "discounted_cash": 3090.31, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of foot lesion", "code_information": [ { "code": "28104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10045.00, "discounted_cash": 6027.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot lesion", "code_information": [ { "code": "28104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10045.00, "discounted_cash": 6027.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of toe lesions", "code_information": [ { "code": "28108", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 1423.58, "maximum": 4173.82, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Part removal of metatarsal", "code_information": [ { "code": "28110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25669.49, "discounted_cash": 15401.69, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Part removal of metatarsal", "code_information": [ { "code": "28110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25669.49, "discounted_cash": 15401.69, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "1 through 10", "median_amount": 1493.38, "10th_percentile": 1493.38, "90th_percentile": 1493.38, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Part removal of metatarsal", "code_information": [ { "code": "28113", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10045.25, "discounted_cash": 6027.15, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of metatarsal", "code_information": [ { "code": "28113", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10045.25, "discounted_cash": 6027.15, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of metatarsal heads", "code_information": [ { "code": "28114", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of heel bone", "code_information": [ { "code": "28118", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8500.50, "discounted_cash": 5100.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of heel spur", "code_information": [ { "code": "28119", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7559.50, "discounted_cash": 4535.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove heel spur", "code_information": [ { "code": "28119", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7559.50, "discounted_cash": 4535.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of foot bone", "code_information": [ { "code": "28122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11127.19, "discounted_cash": 6676.31, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of foot bone", "code_information": [ { "code": "28122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11127.19, "discounted_cash": 6676.31, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of toe", "code_information": [ { "code": "28124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of toe", "code_information": [ { "code": "28124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10045.00, "discounted_cash": 6027.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of toe", "code_information": [ { "code": "28126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of toe", "code_information": [ { "code": "28150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of toe", "code_information": [ { "code": "28160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of toe", "code_information": [ { "code": "28160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10335.50, "discounted_cash": 6201.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial rmvl toe at jnt", "code_information": [ { "code": "28160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10335.50, "discounted_cash": 6201.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect phalanx of toe tumor", "code_information": [ { "code": "28175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 1423.58, "maximum": 4173.82, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal fb subq foot", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1839.75, "discounted_cash": 1103.85, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot foreign body", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1839.75, "discounted_cash": 1103.85, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot fb deep", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot foreign body", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6654.50, "discounted_cash": 3992.70, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of foot tendon", "code_information": [ { "code": "28200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2569.00, "discounted_cash": 1541.40, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair tendon flexor pri/sec", "code_information": [ { "code": "28200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2569.00, "discounted_cash": 1541.40, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of toe tendon", "code_information": [ { "code": "28232", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55359.94, "discounted_cash": 33215.96, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release foot contracture", "code_information": [ { "code": "28270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22970.00, "discounted_cash": 13782.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release of foot contracture", "code_information": [ { "code": "28270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22970.00, "discounted_cash": 13782.00, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of hammertoe", "code_information": [ { "code": "28285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of hammertoe", "code_information": [ { "code": "28285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38014.82, "discounted_cash": 22808.89, "minimum": 2886.11, "maximum": 8461.84, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of foot bone", "code_information": [ { "code": "28288", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22041.00, "discounted_cash": 13224.60, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Corrj halux rigdus w/implt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25333.67, "discounted_cash": 15200.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correct hallus vgs prx phlx bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8500.50, "discounted_cash": 5100.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8500.50, "discounted_cash": 5100.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correct hallus valgus prox met", "code_information": [ { "code": "28295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8204.50, "discounted_cash": 4922.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8204.50, "discounted_cash": 4922.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correct hallus valgus dis met", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8204.50, "discounted_cash": 4922.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8204.50, "discounted_cash": 4922.70, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69482.00, "discounted_cash": 41689.20, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69482.00, "discounted_cash": 41689.20, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5696.56, "10th_percentile": 5696.56, "90th_percentile": 5696.56, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correct hallus vgs dbl osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18788.00, "discounted_cash": 11272.80, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Correction hallux valgus", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18788.00, "discounted_cash": 11272.80, "minimum": 6354.41, "maximum": 18630.62, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revision of big toe", "code_information": [ { "code": "28310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 6354.41, "maximum": 18630.62, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revision of toe", "code_information": [ { "code": "28312", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of sesamoid bone", "code_information": [ { "code": "28315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2756.25, "discounted_cash": 1653.75, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect enlarged toe", "code_information": [ { "code": "28341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11228.44, "discounted_cash": 6737.06, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair webbed toe(s)", "code_information": [ { "code": "28345", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22507.80, "discounted_cash": 13504.68, "minimum": 1423.58, "maximum": 4173.82, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cltx metatarsophlngl jt dislc", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat toe dislocation", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closed tx interphalangeal jnt", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.25, "discounted_cash": 475.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat toe dislocation", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.25, "discounted_cash": 475.35, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fusion of foot bones", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18231.75, "discounted_cash": 10939.05, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fusion of big toe joint", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47311.20, "discounted_cash": 28386.72, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation metatarsal w toe", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1438.50, "discounted_cash": 863.10, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation toe & metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1438.50, "discounted_cash": 863.10, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 37480.70, "discounted_cash": 22488.42, "minimum": 2886.11, "maximum": 8461.84, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14393.25, "discounted_cash": 8635.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Foot/toes surgery procedure", "code_information": [ { "code": "28899", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.25, "discounted_cash": 166.95, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Unlisted procedure foot/toes", "code_information": [ { "code": "28899", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.25, "discounted_cash": 166.95, "minimum": 213.38, "maximum": 625.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 625.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 213.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application cast long arm", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 764.25, "discounted_cash": 458.55, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of long arm cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 764.25, "discounted_cash": 458.55, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of forearm cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30528.75, "discounted_cash": 18317.25, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cast application short arm", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30528.75, "discounted_cash": 18317.25, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application long arm splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 543.25, "discounted_cash": 325.95, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "1 through 10", "median_amount": 435.19, "10th_percentile": 435.19, "90th_percentile": 435.19, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply long arm splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 543.25, "discounted_cash": 325.95, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "1 through 10", "median_amount": 435.19, "10th_percentile": 435.19, "90th_percentile": 435.19, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application short arm splint", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 134.39, "10th_percentile": 134.39, "90th_percentile": 134.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 275.24, "10th_percentile": 259.29, "90th_percentile": 291.19, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 26.12, "90th_percentile": 45.39, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 133.04, "10th_percentile": 127.95, "90th_percentile": 133.04, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.31, "10th_percentile": 100.31, "90th_percentile": 100.31, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.60, "10th_percentile": 10.89, "90th_percentile": 89.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.21, "10th_percentile": 9.21, "90th_percentile": 9.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.21, "10th_percentile": 9.21, "90th_percentile": 9.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Apply forearm splint", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 134.39, "10th_percentile": 134.39, "90th_percentile": 134.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 275.24, "10th_percentile": 259.29, "90th_percentile": 291.19, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 26.12, "90th_percentile": 45.39, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 133.04, "10th_percentile": 127.95, "90th_percentile": 133.04, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.31, "10th_percentile": 100.31, "90th_percentile": 100.31, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.60, "10th_percentile": 10.89, "90th_percentile": 89.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.21, "10th_percentile": 9.21, "90th_percentile": 9.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.21, "10th_percentile": 9.21, "90th_percentile": 9.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Apply forearm splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply short arm splint dynamic", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of finger splint", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 27.25, "90th_percentile": 44.09, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.01, "10th_percentile": 19.01, "90th_percentile": 19.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply finger splint static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 27.25, "90th_percentile": 44.09, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.01, "10th_percentile": 19.01, "90th_percentile": 19.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping hand or finger", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of hand or finger", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application short leg cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.50, "discounted_cash": 556.50, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply short leg cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.50, "discounted_cash": 556.50, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply rigid leg cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 815.25, "discounted_cash": 489.15, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total contact cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 815.25, "discounted_cash": 489.15, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application long leg splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 543.25, "discounted_cash": 325.95, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "1 through 10", "median_amount": 457.06, "10th_percentile": 457.06, "90th_percentile": 457.06, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application lower leg splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 543.25, "discounted_cash": 325.95, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.38, "10th_percentile": 161.16, "90th_percentile": 167.60, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "1 through 10", "median_amount": 405.51, "10th_percentile": 285.23, "90th_percentile": 423.54, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 347.65, "10th_percentile": 293.24, "90th_percentile": 402.07, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.24, "10th_percentile": 42.49, "90th_percentile": 57.50, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.25, "10th_percentile": 49.35, "90th_percentile": 157.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.70, "10th_percentile": 140.70, "90th_percentile": 140.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 500.44, "10th_percentile": 500.44, "90th_percentile": 500.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 500.44, "10th_percentile": 500.44, "90th_percentile": 500.44, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Application short leg cast", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 543.25, "discounted_cash": 325.95, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.38, "10th_percentile": 161.16, "90th_percentile": 167.60, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "1 through 10", "median_amount": 405.51, "10th_percentile": 285.23, "90th_percentile": 423.54, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 347.65, "10th_percentile": 293.24, "90th_percentile": 402.07, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.24, "10th_percentile": 42.49, "90th_percentile": 57.50, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.25, "10th_percentile": 49.35, "90th_percentile": 157.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.70, "10th_percentile": 140.70, "90th_percentile": 140.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 500.44, "10th_percentile": 500.44, "90th_percentile": 500.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 500.44, "10th_percentile": 500.44, "90th_percentile": 500.44, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Strapping knee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of knee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping ankle/foot", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 543.25, "discounted_cash": 325.95, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of ankle and/or ft", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 543.25, "discounted_cash": 325.95, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of toes", "code_information": [ { "code": "29550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 42.75, "discounted_cash": 25.65, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of paste boot", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1308.19, "discounted_cash": 784.91, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 139.41, "10th_percentile": 117.71, "90th_percentile": 161.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.20, "10th_percentile": 76.20, "90th_percentile": 86.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of paste boot", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1166.80, "discounted_cash": 700.08, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.58, "10th_percentile": 129.58, "90th_percentile": 129.58, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.65, "10th_percentile": 84.65, "90th_percentile": 84.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply multlay comprs lwr leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1171.99, "discounted_cash": 703.19, "minimum": 140.36, "maximum": 411.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 411.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 254.08, "10th_percentile": 254.08, "90th_percentile": 254.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.43, "10th_percentile": 76.20, "90th_percentile": 87.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rem gauntlet boot body cast", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 713.25, "discounted_cash": 427.95, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal/revision of cast", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 713.25, "discounted_cash": 427.95, "minimum": 236.24, "maximum": 692.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 692.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 236.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthoscopy shoulder capsulorra", "code_information": [ { "code": "29806", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18787.75, "discounted_cash": 11272.65, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29806", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18787.75, "discounted_cash": 11272.65, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rep shldr slap les", "code_information": [ { "code": "29807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy shldr rmv fb", "code_information": [ { "code": "29819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8500.50, "discounted_cash": 5100.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8500.50, "discounted_cash": 5100.30, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62055.05, "discounted_cash": 37233.03, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62055.05, "discounted_cash": 37233.03, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29822", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 40378.38, "discounted_cash": 24227.03, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29822", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 34460.37, "discounted_cash": 20676.22, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2712.54, "10th_percentile": 2712.54, "90th_percentile": 2712.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29822", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41132.70, "discounted_cash": 24679.62, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1734.72, "10th_percentile": 1734.72, "90th_percentile": 1734.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29823", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41925.54, "discounted_cash": 25155.32, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29823", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41925.54, "discounted_cash": 25155.32, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29824", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61098.88, "discounted_cash": 36659.33, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29824", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61576.97, "discounted_cash": 36946.18, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4151.91, "10th_percentile": 4151.91, "90th_percentile": 4151.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29824", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64675.15, "discounted_cash": 38805.09, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45650.66, "discounted_cash": 27390.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47933.97, "discounted_cash": 28760.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.39, "10th_percentile": 124.39, "90th_percentile": 124.39, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.27, "10th_percentile": 81.27, "90th_percentile": 81.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46570.01, "discounted_cash": 27942.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 248.78, "10th_percentile": 248.78, "90th_percentile": 248.78, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 786.45, "10th_percentile": 786.45, "90th_percentile": 786.45, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscop rotator cuff repr", "code_information": [ { "code": "29827", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56608.69, "discounted_cash": 33965.21, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscop rotator cuff repr", "code_information": [ { "code": "29827", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45948.07, "discounted_cash": 27568.84, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14547.31, "10th_percentile": 14547.31, "90th_percentile": 14547.31, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscop rotator cuff repr", "code_information": [ { "code": "29827", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55849.75, "discounted_cash": 33509.85, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9182.82, "10th_percentile": 9182.82, "90th_percentile": 9182.82, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4369.34, "10th_percentile": 4369.34, "90th_percentile": 4369.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "1 through 10", "median_amount": 8358.03, "10th_percentile": 8358.03, "90th_percentile": 8358.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy biceps tenodesis", "code_information": [ { "code": "29828", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53310.34, "discounted_cash": 31986.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy biceps tenodesis", "code_information": [ { "code": "29828", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56623.78, "discounted_cash": 33974.27, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy biceps tenodesis", "code_information": [ { "code": "29828", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53960.26, "discounted_cash": 32376.16, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wrist endoscopy/surgery", "code_information": [ { "code": "29848", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4303.50, "discounted_cash": 2582.10, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wrist endoscopy/surgery", "code_information": [ { "code": "29848", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4303.50, "discounted_cash": 2582.10, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "1 through 10", "median_amount": 1090.06, "10th_percentile": 1090.06, "90th_percentile": 1090.06, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 842.80, "10th_percentile": 842.80, "90th_percentile": 842.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wrist endoscopy/surgery", "code_information": [ { "code": "29848", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4124.75, "discounted_cash": 2474.85, "minimum": 1423.58, "maximum": 4173.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4173.82, "count": "1 through 10", "median_amount": 928.53, "10th_percentile": 799.32, "90th_percentile": 1057.75, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4173.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1423.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Autgrft implnt knee w/scope", "code_information": [ { "code": "29866", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx knee arthroscopy", "code_information": [ { "code": "29870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy dx", "code_information": [ { "code": "29870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy knee lim synovecto", "code_information": [ { "code": "29875", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29875", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29877", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55944.91, "discounted_cash": 33566.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29877", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55944.91, "discounted_cash": 33566.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy knee abras arthrop", "code_information": [ { "code": "29879", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29879", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19960.38, "discounted_cash": 11976.23, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21852.03, "discounted_cash": 13111.22, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 20988.77, "discounted_cash": 12593.26, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 20074.70, "discounted_cash": 12044.82, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19753.41, "discounted_cash": 11852.05, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "1 through 10", "median_amount": 10046.89, "10th_percentile": 9580.60, "90th_percentile": 10513.17, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3826.91, "10th_percentile": 3826.91, "90th_percentile": 3826.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2712.54, "10th_percentile": 2712.54, "90th_percentile": 2712.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3642.97, "10th_percentile": 3504.14, "90th_percentile": 3642.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19229.26, "discounted_cash": 11537.56, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3456.51, "10th_percentile": 3456.51, "90th_percentile": 3456.51, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4553.71, "10th_percentile": 4553.71, "90th_percentile": 4553.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25370.59, "discounted_cash": 15222.35, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 20127.46, "discounted_cash": 12076.48, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21438.24, "discounted_cash": 12862.94, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthrosc knee w men rpr med la", "code_information": [ { "code": "29883", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29883", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13393.25, "discounted_cash": 8035.95, "minimum": 2886.11, "maximum": 8461.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8461.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2886.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscopy acl rpr", "code_information": [ { "code": "29888", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29888", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dr abscess hematoma nasal", "code_information": [ { "code": "30000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 813.25, "discounted_cash": 487.95, "minimum": 206.56, "maximum": 605.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 206.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of nose lesion", "code_information": [ { "code": "30000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 813.25, "discounted_cash": 487.95, "minimum": 206.56, "maximum": 605.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 206.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fb removal intranasal", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove nasal foreign body", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Control of nosebleed", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nasal hemorrhage simple", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Control of nosebleed", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 296.69, "10th_percentile": 296.69, "90th_percentile": 296.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.71, "10th_percentile": 82.71, "90th_percentile": 82.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nasal hemorrhage complex", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 296.69, "10th_percentile": 296.69, "90th_percentile": 296.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.71, "10th_percentile": 82.71, "90th_percentile": 82.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Control of nosebleed", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 590.75, "discounted_cash": 354.45, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.19, "10th_percentile": 47.42, "90th_percentile": 86.95, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nasal hemorrhage posterior/pac", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 590.75, "discounted_cash": 354.45, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.19, "10th_percentile": 47.42, "90th_percentile": 86.95, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Upper gi endoscopy performed", "code_information": [ { "code": "3130F", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Endotrach intubation", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 813.25, "discounted_cash": 487.95, "minimum": 206.56, "maximum": 605.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.11, "10th_percentile": 241.30, "90th_percentile": 250.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 605.62, "count": "1 through 10", "median_amount": 684.23, "10th_percentile": 684.23, "90th_percentile": 684.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 651.21, "10th_percentile": 651.21, "90th_percentile": 677.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 684.28, "10th_percentile": 684.28, "90th_percentile": 684.28, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.60, "10th_percentile": 77.04, "90th_percentile": 83.50, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 206.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.07, "10th_percentile": 247.07, "90th_percentile": 247.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.07, "10th_percentile": 247.07, "90th_percentile": 247.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 210.66, "10th_percentile": 210.66, "90th_percentile": 210.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert emergency airway", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 813.25, "discounted_cash": 487.95, "minimum": 206.56, "maximum": 605.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.11, "10th_percentile": 241.30, "90th_percentile": 250.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 605.62, "count": "1 through 10", "median_amount": 684.23, "10th_percentile": 684.23, "90th_percentile": 684.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 651.21, "10th_percentile": 651.21, "90th_percentile": 677.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 684.28, "10th_percentile": 684.28, "90th_percentile": 684.28, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.60, "10th_percentile": 77.04, "90th_percentile": 83.50, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 206.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.07, "10th_percentile": 247.07, "90th_percentile": 247.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.07, "10th_percentile": 247.07, "90th_percentile": 247.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 210.66, "10th_percentile": 210.66, "90th_percentile": 210.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Change of windpipe airway", "code_information": [ { "code": "31502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 813.25, "discounted_cash": 487.95, "minimum": 206.56, "maximum": 605.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 206.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tracheotomy tube change", "code_information": [ { "code": "31502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 813.25, "discounted_cash": 487.95, "minimum": 206.56, "maximum": 605.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 605.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 206.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Airways surgical procedure", "code_information": [ { "code": "31899", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30664.41, "discounted_cash": 18398.65, "minimum": 172.69, "maximum": 506.31, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 506.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 506.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 172.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert pleural cath", "code_information": [ { "code": "32550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 40564.56, "discounted_cash": 24338.74, "minimum": 3139.13, "maximum": 9203.68, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insertion of chest tube", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5403.75, "discounted_cash": 3242.25, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 554.77, "10th_percentile": 554.77, "90th_percentile": 554.77, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "1 through 10", "median_amount": 1454.38, "10th_percentile": 1454.38, "90th_percentile": 1454.38, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tube thoracostomy", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5403.75, "discounted_cash": 3242.25, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 554.77, "10th_percentile": 554.77, "90th_percentile": 554.77, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "1 through 10", "median_amount": 1454.38, "10th_percentile": 1454.38, "90th_percentile": 1454.38, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirate pleura w/o imaging", "code_information": [ { "code": "32554", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2077.25, "discounted_cash": 1246.35, "minimum": 549.95, "maximum": 1612.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1612.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1612.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 549.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thoracentesis wo imaging", "code_information": [ { "code": "32554", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2077.25, "discounted_cash": 1246.35, "minimum": 549.95, "maximum": 1612.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1612.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1612.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 549.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirate pleura w/ imaging", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17593.98, "discounted_cash": 10556.39, "minimum": 549.95, "maximum": 1612.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1612.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1612.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 189.36, "10th_percentile": 189.36, "90th_percentile": 189.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 549.95, "count": "1 through 10", "median_amount": 447.22, "10th_percentile": 447.22, "90th_percentile": 447.22, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert cath pleura w/o image", "code_information": [ { "code": "32556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 40564.56, "discounted_cash": 24338.74, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert cath pleura w/o image", "code_information": [ { "code": "32556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1069.50, "discounted_cash": 641.70, "minimum": 1687.39, "maximum": 4947.29, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert cath pleura w/ image", "code_information": [ { "code": "32557", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 40564.56, "discounted_cash": 24338.74, "minimum": 1381.80, "maximum": 4051.32, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecmo/ecls insj prph cannula", "code_information": [ { "code": "33951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39667.36, "discounted_cash": 23800.42, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecmo/ecls insj prph cannula", "code_information": [ { "code": "33952", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39667.36, "discounted_cash": 23800.42, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecmo/ecls rmvl perph cannula", "code_information": [ { "code": "33969", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28920.23, "discounted_cash": 17352.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecmo/ecls rmvl prph cannula", "code_information": [ { "code": "33984", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28920.23, "discounted_cash": 17352.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecmo/ecls rmvl ctr cannula", "code_information": [ { "code": "33985", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28920.23, "discounted_cash": 17352.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecmo/ecls rmvl ctr cannula", "code_information": [ { "code": "33986", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28920.23, "discounted_cash": 17352.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair blood vessel lesion", "code_information": [ { "code": "35226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2171.50, "discounted_cash": 1302.90, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair vessel graft defect", "code_information": [ { "code": "35870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31267.66, "discounted_cash": 18760.60, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place needle in vein", "code_information": [ { "code": "36000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28292.69, "discounted_cash": 16975.61, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place catheter in vein", "code_information": [ { "code": "36010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19854.49, "discounted_cash": 11912.69, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place catheter in vein", "code_information": [ { "code": "36011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11432.08, "discounted_cash": 6859.25, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place catheter in vein", "code_information": [ { "code": "36012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28099.19, "discounted_cash": 16859.51, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Routine venipuncture", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.25, "discounted_cash": 32.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 23.16, "10th_percentile": 20.62, "90th_percentile": 25.69, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 23.16, "10th_percentile": 20.62, "90th_percentile": 25.69, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 6.79, "10th_percentile": 6.33, "90th_percentile": 7.26, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.43, "10th_percentile": 8.43, "90th_percentile": 8.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1646", "median_amount": 27.19, "10th_percentile": 7.59, "90th_percentile": 28.66, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "98", "median_amount": 27.93, "10th_percentile": 8.62, "90th_percentile": 28.66, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "2127", "median_amount": 8.60, "10th_percentile": 8.43, "90th_percentile": 8.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "205", "median_amount": 8.43, "10th_percentile": 6.74, "90th_percentile": 9.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1175", "median_amount": 8.89, "10th_percentile": 8.43, "90th_percentile": 8.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "36", "median_amount": 21.56, "10th_percentile": 7.96, "90th_percentile": 26.95, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "36", "median_amount": 21.56, "10th_percentile": 7.96, "90th_percentile": 26.95, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "354", "median_amount": 7.96, "10th_percentile": 7.55, "90th_percentile": 9.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "76", "median_amount": 25.56, "10th_percentile": 8.89, "90th_percentile": 26.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "76", "median_amount": 25.56, "10th_percentile": 8.89, "90th_percentile": 26.95, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Venipuncture routine", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.25, "discounted_cash": 32.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 23.16, "10th_percentile": 20.62, "90th_percentile": 25.69, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 23.16, "10th_percentile": 20.62, "90th_percentile": 25.69, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 6.79, "10th_percentile": 6.33, "90th_percentile": 7.26, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.43, "10th_percentile": 8.43, "90th_percentile": 8.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1646", "median_amount": 27.19, "10th_percentile": 7.59, "90th_percentile": 28.66, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "98", "median_amount": 27.93, "10th_percentile": 8.62, "90th_percentile": 28.66, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "2127", "median_amount": 8.60, "10th_percentile": 8.43, "90th_percentile": 8.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "205", "median_amount": 8.43, "10th_percentile": 6.74, "90th_percentile": 9.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1175", "median_amount": 8.89, "10th_percentile": 8.43, "90th_percentile": 8.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "36", "median_amount": 21.56, "10th_percentile": 7.96, "90th_percentile": 26.95, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "36", "median_amount": 21.56, "10th_percentile": 7.96, "90th_percentile": 26.95, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "354", "median_amount": 7.96, "10th_percentile": 7.55, "90th_percentile": 9.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "76", "median_amount": 25.56, "10th_percentile": 8.89, "90th_percentile": 26.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "76", "median_amount": 25.56, "10th_percentile": 8.89, "90th_percentile": 26.95, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Capillary blood draw", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.25, "discounted_cash": 15.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Finger/heel stick", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.25, "discounted_cash": 15.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood transfusion", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1173.50, "discounted_cash": 704.10, "minimum": 388.88, "maximum": 1140.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1140.15, "count": "1 through 10", "median_amount": 758.50, "10th_percentile": 659.62, "90th_percentile": 857.39, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1140.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 415.99, "10th_percentile": 272.48, "90th_percentile": 559.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1006.65, "10th_percentile": 1006.65, "90th_percentile": 1006.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 120.47, "10th_percentile": 115.00, "90th_percentile": 126.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 388.88, "count": "1 through 10", "median_amount": 342.96, "10th_percentile": 342.96, "90th_percentile": 342.96, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 351.64, "10th_percentile": 341.93, "90th_percentile": 361.36, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 356.52, "10th_percentile": 342.91, "90th_percentile": 356.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1081.03, "10th_percentile": 1081.03, "90th_percentile": 1081.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1081.03, "10th_percentile": 1081.03, "90th_percentile": 1081.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 319.19, "10th_percentile": 319.19, "90th_percentile": 319.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood transfusion service", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22658.88, "discounted_cash": 13595.33, "minimum": 388.88, "maximum": 1140.15, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1140.15, "count": "1 through 10", "median_amount": 758.50, "10th_percentile": 659.62, "90th_percentile": 857.39, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1140.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 415.99, "10th_percentile": 272.48, "90th_percentile": 559.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1006.65, "10th_percentile": 1006.65, "90th_percentile": 1006.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 120.47, "10th_percentile": 115.00, "90th_percentile": 126.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 388.88, "count": "1 through 10", "median_amount": 342.96, "10th_percentile": 342.96, "90th_percentile": 342.96, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 351.64, "10th_percentile": 341.93, "90th_percentile": 361.36, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 356.52, "10th_percentile": 342.91, "90th_percentile": 356.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1081.03, "10th_percentile": 1081.03, "90th_percentile": 1081.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1081.03, "10th_percentile": 1081.03, "90th_percentile": 1081.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 319.19, "10th_percentile": 319.19, "90th_percentile": 319.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood transfusion service", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1173.50, "discounted_cash": 704.10, "minimum": 388.88, "maximum": 1140.15, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1140.15, "count": "1 through 10", "median_amount": 758.50, "10th_percentile": 659.62, "90th_percentile": 857.39, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1140.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 415.99, "10th_percentile": 272.48, "90th_percentile": 559.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1006.65, "10th_percentile": 1006.65, "90th_percentile": 1006.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 120.47, "10th_percentile": 115.00, "90th_percentile": 126.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 388.88, "count": "1 through 10", "median_amount": 342.96, "10th_percentile": 342.96, "90th_percentile": 342.96, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 351.64, "10th_percentile": 341.93, "90th_percentile": 361.36, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 356.52, "10th_percentile": 342.91, "90th_percentile": 356.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1081.03, "10th_percentile": 1081.03, "90th_percentile": 1081.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1081.03, "10th_percentile": 1081.03, "90th_percentile": 1081.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 319.19, "10th_percentile": 319.19, "90th_percentile": 319.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bl push transfuse 2 yr/<", "code_information": [ { "code": "36440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22658.88, "discounted_cash": 13595.33, "minimum": 388.88, "maximum": 1140.15, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1140.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1140.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 388.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insertion of catheter vein", "code_information": [ { "code": "36510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 418.00, "discounted_cash": 250.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert non-tunnel cv cath", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31105.42, "discounted_cash": 18663.25, "minimum": 2799.73, "maximum": 8208.58, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 751.91, "10th_percentile": 751.91, "90th_percentile": 782.04, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2383.36, "10th_percentile": 1532.98, "90th_percentile": 2446.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 249.61, "10th_percentile": 71.35, "90th_percentile": 264.09, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "1 through 10", "median_amount": 700.53, "10th_percentile": 635.62, "90th_percentile": 765.45, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 755.33, "10th_percentile": 740.56, "90th_percentile": 770.09, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 698.98, "10th_percentile": 668.66, "90th_percentile": 729.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 758.72, "10th_percentile": 705.97, "90th_percentile": 811.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert non-tunnel cv cath", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13991.16, "discounted_cash": 8394.70, "minimum": 2799.73, "maximum": 8208.58, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 751.91, "10th_percentile": 751.91, "90th_percentile": 782.04, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2383.36, "10th_percentile": 1532.98, "90th_percentile": 2446.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 249.61, "10th_percentile": 71.35, "90th_percentile": 264.09, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "1 through 10", "median_amount": 700.53, "10th_percentile": 635.62, "90th_percentile": 765.45, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 755.33, "10th_percentile": 740.56, "90th_percentile": 770.09, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 698.98, "10th_percentile": 668.66, "90th_percentile": 729.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 758.72, "10th_percentile": 705.97, "90th_percentile": 811.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert non-tunnel cv cath", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13991.16, "discounted_cash": 8394.70, "minimum": 2799.73, "maximum": 8208.58, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36557", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32608.54, "discounted_cash": 19565.12, "minimum": 4808.42, "maximum": 14097.90, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4808.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31105.42, "discounted_cash": 18663.25, "minimum": 2799.73, "maximum": 8208.58, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 796.29, "10th_percentile": 796.29, "90th_percentile": 796.29, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12376.89, "discounted_cash": 7426.13, "minimum": 2799.73, "maximum": 8208.58, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 796.29, "10th_percentile": 796.29, "90th_percentile": 796.29, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36558", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12376.89, "discounted_cash": 7426.13, "minimum": 2799.73, "maximum": 8208.58, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31105.42, "discounted_cash": 18663.25, "minimum": 2799.73, "maximum": 8208.58, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31105.42, "discounted_cash": 18663.25, "minimum": 2799.73, "maximum": 8208.58, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 783.71, "10th_percentile": 754.77, "90th_percentile": 812.65, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13045.08, "discounted_cash": 7827.05, "minimum": 2799.73, "maximum": 8208.58, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 783.71, "10th_percentile": 754.77, "90th_percentile": 812.65, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13045.08, "discounted_cash": 7827.05, "minimum": 2799.73, "maximum": 8208.58, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "1 through 10", "median_amount": 5390.59, "10th_percentile": 5390.59, "90th_percentile": 5390.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 820.10, "10th_percentile": 647.19, "90th_percentile": 1547.28, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "1 through 10", "median_amount": 2474.61, "10th_percentile": 2048.52, "90th_percentile": 2900.71, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1876.68, "10th_percentile": 1876.68, "90th_percentile": 1876.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1474.70, "10th_percentile": 1474.70, "90th_percentile": 1474.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2419.24, "10th_percentile": 2419.24, "90th_percentile": 2419.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12715.17, "discounted_cash": 7629.10, "minimum": 2799.73, "maximum": 8208.58, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36563", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31105.42, "discounted_cash": 18663.25, "minimum": 4808.42, "maximum": 14097.90, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4808.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31105.42, "discounted_cash": 18663.25, "minimum": 2799.73, "maximum": 8208.58, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36566", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31105.42, "discounted_cash": 18663.25, "minimum": 4808.42, "maximum": 14097.90, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4808.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36566", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1188.25, "discounted_cash": 712.95, "minimum": 4808.42, "maximum": 14097.90, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4808.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunnled cv cath 2 sites", "code_information": [ { "code": "36566", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1188.25, "discounted_cash": 712.95, "minimum": 4808.42, "maximum": 14097.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 14097.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4808.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insj picc <5 yr w/o imaging", "code_information": [ { "code": "36568", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28099.19, "discounted_cash": 16859.51, "minimum": 1381.80, "maximum": 4051.32, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insj picc 5 yr+ w/o imaging", "code_information": [ { "code": "36569", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5403.75, "discounted_cash": 3242.25, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Picc line greater than 5 years", "code_information": [ { "code": "36569", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5403.75, "discounted_cash": 3242.25, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insertion picc w rs&i 5 yr+", "code_information": [ { "code": "36573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3325.50, "discounted_cash": 1995.30, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2434.77, "10th_percentile": 2434.77, "90th_percentile": 2434.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insj picc rs&i 5 yr+", "code_information": [ { "code": "36573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3325.50, "discounted_cash": 1995.30, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2434.77, "10th_percentile": 2434.77, "90th_percentile": 2434.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Compl rplcmt picc rs&i", "code_information": [ { "code": "36584", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 125.00, "discounted_cash": 75.00, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal tunneled cv cath", "code_information": [ { "code": "36590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28920.23, "discounted_cash": 17352.14, "minimum": 1381.80, "maximum": 4051.32, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal tunneled cv cath", "code_information": [ { "code": "36590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.75, "discounted_cash": 260.25, "minimum": 1381.80, "maximum": 4051.32, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove tunneled cvad w port", "code_information": [ { "code": "36590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.75, "discounted_cash": 260.25, "minimum": 1381.80, "maximum": 4051.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4051.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1381.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collection of blood from vad", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Draw blood off venous device", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collect blood from picc", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 128.43, "10th_percentile": 111.92, "90th_percentile": 365.55, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.45, "10th_percentile": 40.45, "90th_percentile": 40.45, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.24, "10th_percentile": 98.24, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Declot vascular device", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Declotting vad or catheter", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arterial puncture", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 82.77, "10th_percentile": 78.82, "90th_percentile": 96.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 222.29, "10th_percentile": 123.34, "90th_percentile": 225.68, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 261.66, "10th_percentile": 249.16, "90th_percentile": 784.98, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 249.16, "10th_percentile": 249.16, "90th_percentile": 259.16, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 26.79, "10th_percentile": 26.17, "90th_percentile": 52.33, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 78.03, "10th_percentile": 78.03, "90th_percentile": 81.95, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 68.47, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 81.12, "10th_percentile": 77.25, "90th_percentile": 162.23, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.36, "10th_percentile": 51.01, "90th_percentile": 65.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Withdrawal of arterial blood", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 82.77, "10th_percentile": 78.82, "90th_percentile": 96.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 222.29, "10th_percentile": 123.34, "90th_percentile": 225.68, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 261.66, "10th_percentile": 249.16, "90th_percentile": 784.98, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 249.16, "10th_percentile": 249.16, "90th_percentile": 259.16, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 26.79, "10th_percentile": 26.17, "90th_percentile": 52.33, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 78.03, "10th_percentile": 78.03, "90th_percentile": 81.95, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 68.47, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 81.12, "10th_percentile": 77.25, "90th_percentile": 162.23, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.36, "10th_percentile": 51.01, "90th_percentile": 65.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert needle bone cavity", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 973.63, "10th_percentile": 973.63, "90th_percentile": 973.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.10, "10th_percentile": 107.10, "90th_percentile": 107.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place needle intraosseous inf", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 973.63, "10th_percentile": 973.63, "90th_percentile": 973.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.10, "10th_percentile": 107.10, "90th_percentile": 107.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thrombolysis cerebral iv infus", "code_information": [ { "code": "37195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 317.42, "10th_percentile": 317.42, "90th_percentile": 317.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thrombolytic therapy stroke", "code_information": [ { "code": "37195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 317.42, "10th_percentile": 317.42, "90th_percentile": 317.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ligate leg veins radical", "code_information": [ { "code": "37760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2799.73, "maximum": 8208.58, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ligate leg veins open", "code_information": [ { "code": "37761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7879.06, "discounted_cash": 4727.44, "minimum": 2799.73, "maximum": 8208.58, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8208.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2799.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of spleen total", "code_information": [ { "code": "38100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2680.50, "discounted_cash": 1608.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Splenectomy total", "code_information": [ { "code": "38100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2680.50, "discounted_cash": 1608.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx bone marrow bx & aspir", "code_information": [ { "code": "38222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8410.00, "discounted_cash": 5046.00, "minimum": 2545.82, "maximum": 7464.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7464.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2545.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy or exc of lymph node", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 580.75, "discounted_cash": 348.45, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy/removal lymph nodes", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49824.30, "discounted_cash": 29894.58, "minimum": 3406.18, "maximum": 9986.64, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy/removal lymph nodes", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 580.75, "discounted_cash": 348.45, "minimum": 3406.18, "maximum": 9986.64, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biop/exc lymph node by needle", "code_information": [ { "code": "38505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1785.00, "discounted_cash": 1071.00, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle biopsy lymph nodes", "code_information": [ { "code": "38505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1785.00, "discounted_cash": 1071.00, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biop/exc lymph node open", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1365.00, "discounted_cash": 819.00, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy/removal lymph nodes", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49824.30, "discounted_cash": 29894.58, "minimum": 3406.18, "maximum": 9986.64, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy/removal lymph nodes", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1365.00, "discounted_cash": 819.00, "minimum": 3406.18, "maximum": 9986.64, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy lymph node axillary", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 990.25, "discounted_cash": 594.15, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy/removal lymph nodes", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 990.25, "discounted_cash": 594.15, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Open bx/exc inguinofem nodes", "code_information": [ { "code": "38531", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3969.00, "discounted_cash": 2381.40, "minimum": 3406.18, "maximum": 9986.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9986.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3406.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair lip", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1738.25, "discounted_cash": 1042.95, "minimum": 452.98, "maximum": 1328.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1328.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1328.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 452.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair lip full thickness vh", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1738.25, "discounted_cash": 1042.95, "minimum": 452.98, "maximum": 1328.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1328.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1328.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 452.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage mouth lesion", "code_information": [ { "code": "40800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2391.50, "discounted_cash": 1434.90, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of mouth lesion", "code_information": [ { "code": "40800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2391.50, "discounted_cash": 1434.90, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair fir mouthant 2/3 tongu", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair tongue laceration", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage abscess dentoalveolar", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 652.50, "discounted_cash": 391.50, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of gum lesion", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 652.50, "discounted_cash": 391.50, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of gum lesion", "code_information": [ { "code": "41825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4007.38, "discounted_cash": 2404.43, "minimum": 2884.74, "maximum": 8457.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2884.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove pharynx foreign body", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2671.39, "discounted_cash": 1602.83, "minimum": 354.95, "maximum": 1040.68, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove tonsils and adenoids", "code_information": [ { "code": "42820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 828.25, "discounted_cash": 496.95, "minimum": 5262.03, "maximum": 15427.86, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15427.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15427.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5262.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tonsillectomy & adenoid <12 yr", "code_information": [ { "code": "42820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 828.25, "discounted_cash": 496.95, "minimum": 5262.03, "maximum": 15427.86, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15427.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15427.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5262.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove tonsils and adenoids", "code_information": [ { "code": "42821", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 862.50, "discounted_cash": 517.50, "minimum": 2884.74, "maximum": 8457.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2884.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tonsillectomy & adenoid 12+", "code_information": [ { "code": "42821", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 862.50, "discounted_cash": 517.50, "minimum": 2884.74, "maximum": 8457.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2884.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of tonsils", "code_information": [ { "code": "42826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 715.50, "discounted_cash": 429.30, "minimum": 2884.74, "maximum": 8457.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2884.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tonsillectomy age 12+", "code_information": [ { "code": "42826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 715.50, "discounted_cash": 429.30, "minimum": 2884.74, "maximum": 8457.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8457.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2884.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagoscopy flexible brush", "code_information": [ { "code": "43200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 761.50, "discounted_cash": 456.90, "minimum": 833.97, "maximum": 2445.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagoscopy flex biopsy", "code_information": [ { "code": "43202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1564.50, "discounted_cash": 938.70, "minimum": 1687.39, "maximum": 4947.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagoscopy w biopsy sng mul", "code_information": [ { "code": "43202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1564.50, "discounted_cash": 938.70, "minimum": 1687.39, "maximum": 4947.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd esophagogastrc fndoplsty", "code_information": [ { "code": "43210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 9260.87, "maximum": 27152.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 27152.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 27152.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 9260.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagoscopy balloon <30mm", "code_information": [ { "code": "43220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2325.25, "discounted_cash": 1395.15, "minimum": 1687.39, "maximum": 4947.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagoscopy lesion ablate", "code_information": [ { "code": "43229", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12216.75, "discounted_cash": 7330.05, "minimum": 3384.16, "maximum": 9922.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3384.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd balloon dil esoph30 mm/>", "code_information": [ { "code": "43233", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd diagnostic brush wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44776.75, "discounted_cash": 26866.05, "minimum": 833.97, "maximum": 2445.13, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 458.14, "10th_percentile": 458.14, "90th_percentile": 458.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1007.56, "10th_percentile": 1007.56, "90th_percentile": 1007.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd diagnostic brush wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9921.17, "discounted_cash": 5952.70, "minimum": 833.97, "maximum": 2445.13, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 458.14, "10th_percentile": 458.14, "90th_percentile": 458.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1007.56, "10th_percentile": 1007.56, "90th_percentile": 1007.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Uppr gi scope w/submuc inj", "code_information": [ { "code": "43236", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 833.97, "maximum": 2445.13, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Endoscopic us exam esoph", "code_information": [ { "code": "43237", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd us fine needle bx/aspir", "code_information": [ { "code": "43238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd biopsy single/multiple", "code_information": [ { "code": "43239", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44776.75, "discounted_cash": 26866.05, "minimum": 833.97, "maximum": 2445.13, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 868.82, "10th_percentile": 583.43, "90th_percentile": 1427.68, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "19", "median_amount": 1776.75, "10th_percentile": 1109.32, "90th_percentile": 2447.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 1968.82, "10th_percentile": 1238.51, "90th_percentile": 3216.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1687.56, "10th_percentile": 1687.56, "90th_percentile": 1687.56, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 195.01, "10th_percentile": 55.29, "90th_percentile": 731.29, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "1 through 10", "median_amount": 1089.99, "10th_percentile": 600.34, "90th_percentile": 1308.48, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 665.22, "10th_percentile": 407.60, "90th_percentile": 919.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1762.56, "10th_percentile": 1762.56, "90th_percentile": 1762.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1762.56, "10th_percentile": 1762.56, "90th_percentile": 1762.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 739.67, "10th_percentile": 559.58, "90th_percentile": 852.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 699.22, "10th_percentile": 699.22, "90th_percentile": 699.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 699.22, "10th_percentile": 699.22, "90th_percentile": 699.22, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Egd biopsy single/multiple", "code_information": [ { "code": "43239", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11308.20, "discounted_cash": 6784.92, "minimum": 833.97, "maximum": 2445.13, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 868.82, "10th_percentile": 583.43, "90th_percentile": 1427.68, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "19", "median_amount": 1776.75, "10th_percentile": 1109.32, "90th_percentile": 2447.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 1968.82, "10th_percentile": 1238.51, "90th_percentile": 3216.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1687.56, "10th_percentile": 1687.56, "90th_percentile": 1687.56, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 195.01, "10th_percentile": 55.29, "90th_percentile": 731.29, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "1 through 10", "median_amount": 1089.99, "10th_percentile": 600.34, "90th_percentile": 1308.48, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 665.22, "10th_percentile": 407.60, "90th_percentile": 919.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1762.56, "10th_percentile": 1762.56, "90th_percentile": 1762.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1762.56, "10th_percentile": 1762.56, "90th_percentile": 1762.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 739.67, "10th_percentile": 559.58, "90th_percentile": 852.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 699.22, "10th_percentile": 699.22, "90th_percentile": 699.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 699.22, "10th_percentile": 699.22, "90th_percentile": 699.22, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Egd w/transmural drain cyst", "code_information": [ { "code": "43240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 5295.08, "maximum": 15524.74, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15524.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15524.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5295.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd tube/cath insertion", "code_information": [ { "code": "43241", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd us fine needle bx/aspir", "code_information": [ { "code": "43242", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd injection varices", "code_information": [ { "code": "43243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd varices ligation", "code_information": [ { "code": "43244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd dilate stricture", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd gastrostomy tube placement", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 732.50, "discounted_cash": 439.50, "minimum": 1687.39, "maximum": 4947.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd place gastrostomy tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd place gastrostomy tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 732.50, "discounted_cash": 439.50, "minimum": 1687.39, "maximum": 4947.29, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd removal fb", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 582.75, "discounted_cash": 349.65, "minimum": 833.97, "maximum": 2445.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd remove foreign body", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 833.97, "maximum": 2445.13, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd remove foreign body", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 582.75, "discounted_cash": 349.65, "minimum": 833.97, "maximum": 2445.13, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd guide wire insertion", "code_information": [ { "code": "43248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 833.97, "maximum": 2445.13, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esoph egd dilation <30 mm", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1627.10, "10th_percentile": 1627.10, "90th_percentile": 1627.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6594.90, "10th_percentile": 6594.90, "90th_percentile": 6594.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esoph egd dilation <30 mm", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41993.05, "discounted_cash": 25195.83, "minimum": 1687.39, "maximum": 4947.29, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1627.10, "10th_percentile": 1627.10, "90th_percentile": 1627.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6594.90, "10th_percentile": 6594.90, "90th_percentile": 6594.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd cautery tumor polyp", "code_information": [ { "code": "43250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd cautery tumor polyp", "code_information": [ { "code": "43250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2541.50, "discounted_cash": 1524.90, "minimum": 1687.39, "maximum": 4947.29, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd remove lesion snare", "code_information": [ { "code": "43251", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd remove lesion snare", "code_information": [ { "code": "43251", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13785.08, "discounted_cash": 8271.05, "minimum": 1687.39, "maximum": 4947.29, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd optical endomicroscopy", "code_information": [ { "code": "43252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd us transmural injxn/mark", "code_information": [ { "code": "43253", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd endo mucosal resection", "code_information": [ { "code": "43254", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd control bleeding any", "code_information": [ { "code": "43255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd w/thrml txmnt gerd", "code_information": [ { "code": "43257", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 3384.16, "maximum": 9922.10, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3384.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd us exam duodenum/jejunum", "code_information": [ { "code": "43259", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd endoscopic stent place", "code_information": [ { "code": "43266", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 5295.08, "maximum": 15524.74, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15524.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15524.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5295.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd lesion ablation", "code_information": [ { "code": "43270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr hiatal hernia lap wo mesh", "code_information": [ { "code": "43332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5357.50, "discounted_cash": 3214.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transab esoph hiat hern rpr", "code_information": [ { "code": "43332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5357.50, "discounted_cash": 3214.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr hiatal hernia w mesh", "code_information": [ { "code": "43333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4738.50, "discounted_cash": 2843.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transab esoph hiat hern rpr", "code_information": [ { "code": "43333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4738.50, "discounted_cash": 2843.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gastrointestinal repair", "code_information": [ { "code": "43360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Free jejunum flap microvasc", "code_information": [ { "code": "43496", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of stomach lesion", "code_information": [ { "code": "43610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of stomach lesion", "code_information": [ { "code": "43611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap gastric bypass/roux-en-y", "code_information": [ { "code": "43644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap gastr bypass incl smll i", "code_information": [ { "code": "43645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopy gastrostomy", "code_information": [ { "code": "43653", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 5189.72, "maximum": 15215.83, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscope proc stom", "code_information": [ { "code": "43659", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 5189.72, "maximum": 15215.83, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nasal/orogastric w/tube plmt", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17406.10, "discounted_cash": 10443.66, "minimum": 354.95, "maximum": 1040.68, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nasal/orogastric w/tube plmt", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Naso gastric tube plmt w fluro", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gastric lavage", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1017.25, "discounted_cash": 610.35, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx gastro intub w/asp", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17406.10, "discounted_cash": 10443.66, "minimum": 276.99, "maximum": 812.12, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx gastro intub w/asp", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1017.25, "discounted_cash": 610.35, "minimum": 276.99, "maximum": 812.12, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx gastr intub w/asp specs", "code_information": [ { "code": "43755", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17406.10, "discounted_cash": 10443.66, "minimum": 139.17, "maximum": 408.04, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reposition g tube", "code_information": [ { "code": "43761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 648.50, "discounted_cash": 389.10, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reposition gastrostomy tube", "code_information": [ { "code": "43761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 648.50, "discounted_cash": 389.10, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rplc gtube no revj trc", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.75, "discounted_cash": 613.65, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.00, "10th_percentile": 105.00, "90th_percentile": 105.00, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.11, "10th_percentile": 188.11, "90th_percentile": 188.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rplc gtube wo image or scope", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.75, "discounted_cash": 613.65, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.00, "10th_percentile": 105.00, "90th_percentile": 105.00, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.11, "10th_percentile": 188.11, "90th_percentile": 188.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap place gastr adj device", "code_information": [ { "code": "43770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 9260.87, "maximum": 27152.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 27152.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 27152.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 9260.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap revise gastr adj device", "code_information": [ { "code": "43771", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap rmvl gastr adj device", "code_information": [ { "code": "43772", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 3384.16, "maximum": 9922.10, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3384.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap replace gastr adj device", "code_information": [ { "code": "43773", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 5189.72, "maximum": 15215.83, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap rmvl gastr adj all parts", "code_information": [ { "code": "43774", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "minimum": 3384.16, "maximum": 9922.10, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9922.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3384.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap sleeve gastrectomy", "code_information": [ { "code": "43775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35500.77, "discounted_cash": 21300.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of stomach lesion", "code_information": [ { "code": "43840", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31267.66, "discounted_cash": 18760.60, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of stomach lesion", "code_information": [ { "code": "43840", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48015.58, "discounted_cash": 28809.35, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enterolysis", "code_information": [ { "code": "44005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2419.25, "discounted_cash": 1451.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Freeing of bowel adhesion", "code_information": [ { "code": "44005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2419.25, "discounted_cash": 1451.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Decompress small bowel", "code_information": [ { "code": "44021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3398.75, "discounted_cash": 2039.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enterotomy small intes decom", "code_information": [ { "code": "44021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3398.75, "discounted_cash": 2039.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise intestine lesion(s)", "code_information": [ { "code": "44110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of bowel lesion(s)", "code_information": [ { "code": "44111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of small intestine", "code_information": [ { "code": "44120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of small intestine", "code_information": [ { "code": "44120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3469.50, "discounted_cash": 2081.70, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect sm intest sgl resect", "code_information": [ { "code": "44120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3469.50, "discounted_cash": 2081.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of small intestine", "code_information": [ { "code": "44121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of small intestine", "code_information": [ { "code": "44125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enterectomy w/o taper cong", "code_information": [ { "code": "44126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enterectomy w/taper cong", "code_information": [ { "code": "44127", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enterectomy cong add-on", "code_information": [ { "code": "44128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bowel to bowel fusion", "code_information": [ { "code": "44130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enterectomy cadaver donor", "code_information": [ { "code": "44132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enterectomy live donor", "code_information": [ { "code": "44133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79777.89, "discounted_cash": 47866.73, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colectomy partial w anastomosi", "code_information": [ { "code": "44140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4805.00, "discounted_cash": 2883.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of colon", "code_information": [ { "code": "44140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4805.00, "discounted_cash": 2883.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colectomy partial", "code_information": [ { "code": "44143", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3863.75, "discounted_cash": 2318.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of colon", "code_information": [ { "code": "44143", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3863.75, "discounted_cash": 2318.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of colon", "code_information": [ { "code": "44160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2775.00, "discounted_cash": 1665.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap close enterostomy", "code_information": [ { "code": "44227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31267.66, "discounted_cash": 18760.60, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscope proc intestine", "code_information": [ { "code": "44238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 5189.72, "maximum": 15215.83, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colostomy", "code_information": [ { "code": "44320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4000.00, "discounted_cash": 2400.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Small bowel endoscopy", "code_information": [ { "code": "44376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 1687.39, "maximum": 4947.29, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4947.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1687.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ileoscopy thru stoma dx", "code_information": [ { "code": "44380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.50, "discounted_cash": 71.10, "minimum": 833.97, "maximum": 2445.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Small bowel endoscopy br/wa", "code_information": [ { "code": "44380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.50, "discounted_cash": 71.10, "minimum": 833.97, "maximum": 2445.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy thru stoma spx", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 810.97, "maximum": 2377.71, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy thru stoma spx", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 971.25, "discounted_cash": 582.75, "minimum": 810.97, "maximum": 2377.71, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy via stoma", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 971.25, "discounted_cash": 582.75, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy via stoma w biopsy", "code_information": [ { "code": "44389", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1200.25, "discounted_cash": 720.15, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy with biopsy", "code_information": [ { "code": "44389", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44759.20, "discounted_cash": 26855.52, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy with biopsy", "code_information": [ { "code": "44389", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1200.25, "discounted_cash": 720.15, "minimum": 1048.80, "maximum": 3075.00, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy via stoma w snare", "code_information": [ { "code": "44394", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1362.50, "discounted_cash": 817.50, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/snare", "code_information": [ { "code": "44394", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1362.50, "discounted_cash": 817.50, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/ultrasound", "code_information": [ { "code": "44406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy thru stoma w decom", "code_information": [ { "code": "44408", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2730.00, "discounted_cash": 1638.00, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/decompression", "code_information": [ { "code": "44408", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2730.00, "discounted_cash": 1638.00, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair bowel opening", "code_information": [ { "code": "44626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5342.50, "discounted_cash": 3205.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2241.75, "discounted_cash": 1345.05, "minimum": 5550.31, "maximum": 16273.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5550.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopy appendectomy", "code_information": [ { "code": "44970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21142.77, "discounted_cash": 12685.66, "minimum": 5189.72, "maximum": 15215.83, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "1 through 10", "median_amount": 11421.34, "10th_percentile": 11421.34, "90th_percentile": 11421.34, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8942.08, "10th_percentile": 6982.40, "90th_percentile": 10901.75, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopy appendectomy", "code_information": [ { "code": "44970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 40085.85, "discounted_cash": 24051.51, "minimum": 5189.72, "maximum": 15215.83, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "1 through 10", "median_amount": 11421.34, "10th_percentile": 11421.34, "90th_percentile": 11421.34, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8942.08, "10th_percentile": 6982.40, "90th_percentile": 10901.75, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of pelvic abscess", "code_information": [ { "code": "45000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35125.50, "discounted_cash": 21075.30, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of rectal abscess", "code_information": [ { "code": "45005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35125.50, "discounted_cash": 21075.30, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of rectal abscess", "code_information": [ { "code": "45005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3984.75, "discounted_cash": 2390.85, "minimum": 1048.80, "maximum": 3075.00, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d abscess rectum", "code_information": [ { "code": "45005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3984.75, "discounted_cash": 2390.85, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of rectal abscess", "code_information": [ { "code": "45020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35125.50, "discounted_cash": 21075.30, "minimum": 2439.38, "maximum": 7152.07, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pelvic exenteration", "code_information": [ { "code": "45126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Proctosigmoidoscopy dx", "code_information": [ { "code": "45300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 810.97, "maximum": 2377.71, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Proctosigmoidoscopy dx", "code_information": [ { "code": "45300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.25, "discounted_cash": 93.15, "minimum": 810.97, "maximum": 2377.71, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Proctosigmoidoscopy ridgid dx", "code_information": [ { "code": "45300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.25, "discounted_cash": 93.15, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Proctosigmoidoscopy w/bx", "code_information": [ { "code": "45305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic sigmoidoscopy", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 810.97, "maximum": 2377.71, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic sigmoidoscopy", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 374.50, "discounted_cash": 224.70, "minimum": 810.97, "maximum": 2377.71, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy dx", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 374.50, "discounted_cash": 224.70, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy and biopsy", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44759.20, "discounted_cash": 26855.52, "minimum": 810.97, "maximum": 2377.71, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy and biopsy", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 464.75, "discounted_cash": 278.85, "minimum": 810.97, "maximum": 2377.71, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy w biopsy", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 464.75, "discounted_cash": 278.85, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy w fb removal", "code_information": [ { "code": "45332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 840.50, "discounted_cash": 504.30, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy w/fb removal", "code_information": [ { "code": "45332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 840.50, "discounted_cash": 504.30, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy w/tumr remove", "code_information": [ { "code": "45338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.75, "discounted_cash": 72.45, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2291.37, "10th_percentile": 2291.37, "90th_percentile": 2291.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2291.37, "10th_percentile": 2291.37, "90th_percentile": 2291.37, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sigmoidoscopy flex remv tumor", "code_information": [ { "code": "45338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.75, "discounted_cash": 72.45, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2291.37, "10th_percentile": 2291.37, "90th_percentile": 2291.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2291.37, "10th_percentile": 2291.37, "90th_percentile": 2291.37, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sigmoidoscopy w/ultrasound", "code_information": [ { "code": "45341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 810.97, "maximum": 2377.71, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy w/us guide bx", "code_information": [ { "code": "45342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30542.02, "discounted_cash": 18325.21, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic colonoscopy", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 810.97, "maximum": 2377.71, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 934.19, "10th_percentile": 635.47, "90th_percentile": 1121.49, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "21", "median_amount": 2536.72, "10th_percentile": 1811.04, "90th_percentile": 3398.26, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 707.03, "10th_percentile": 389.51, "90th_percentile": 2746.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1150.63, "10th_percentile": 487.47, "90th_percentile": 1813.79, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 340.33, "10th_percentile": 201.42, "90th_percentile": 437.67, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "1 through 10", "median_amount": 796.86, "10th_percentile": 723.08, "90th_percentile": 870.64, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 676.10, "10th_percentile": 406.46, "90th_percentile": 853.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1127.61, "10th_percentile": 777.10, "90th_percentile": 2180.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic colonoscopy", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7595.21, "discounted_cash": 4557.13, "minimum": 810.97, "maximum": 2377.71, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 934.19, "10th_percentile": 635.47, "90th_percentile": 1121.49, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "21", "median_amount": 2536.72, "10th_percentile": 1811.04, "90th_percentile": 3398.26, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 707.03, "10th_percentile": 389.51, "90th_percentile": 2746.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1150.63, "10th_percentile": 487.47, "90th_percentile": 1813.79, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 340.33, "10th_percentile": 201.42, "90th_percentile": 437.67, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "1 through 10", "median_amount": 796.86, "10th_percentile": 723.08, "90th_percentile": 870.64, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 676.10, "10th_percentile": 406.46, "90th_percentile": 853.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1127.61, "10th_percentile": 777.10, "90th_percentile": 2180.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/fb removal", "code_information": [ { "code": "45379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy and biopsy", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44759.20, "discounted_cash": 26855.52, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3344.39, "10th_percentile": 3344.39, "90th_percentile": 3344.39, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3344.39, "10th_percentile": 3344.39, "90th_percentile": 3344.39, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1308.51, "10th_percentile": 1046.81, "90th_percentile": 1458.05, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "1 through 10", "median_amount": 2677.42, "10th_percentile": 2266.95, "90th_percentile": 4304.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2194.54, "10th_percentile": 1646.83, "90th_percentile": 2723.65, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 417.68, "10th_percentile": 160.01, "90th_percentile": 780.04, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1264.74, "10th_percentile": 665.76, "90th_percentile": 1578.24, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 915.96, "10th_percentile": 381.83, "90th_percentile": 1617.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1066.11, "10th_percentile": 770.88, "90th_percentile": 1361.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy and biopsy", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11558.39, "discounted_cash": 6935.03, "minimum": 1048.80, "maximum": 3075.00, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3344.39, "10th_percentile": 3344.39, "90th_percentile": 3344.39, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3344.39, "10th_percentile": 3344.39, "90th_percentile": 3344.39, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1308.51, "10th_percentile": 1046.81, "90th_percentile": 1458.05, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "1 through 10", "median_amount": 2677.42, "10th_percentile": 2266.95, "90th_percentile": 4304.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2194.54, "10th_percentile": 1646.83, "90th_percentile": 2723.65, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 417.68, "10th_percentile": 160.01, "90th_percentile": 780.04, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1264.74, "10th_percentile": 665.76, "90th_percentile": 1578.24, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 915.96, "10th_percentile": 381.83, "90th_percentile": 1617.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1066.11, "10th_percentile": 770.88, "90th_percentile": 1361.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy submucous njx", "code_information": [ { "code": "45381", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1356.25, "discounted_cash": 813.75, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w submucosal inj", "code_information": [ { "code": "45381", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1356.25, "discounted_cash": 813.75, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/ lesion removal", "code_information": [ { "code": "45384", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1288.50, "discounted_cash": 773.10, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/lesion removal", "code_information": [ { "code": "45384", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1288.50, "discounted_cash": 773.10, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/lesion removal", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12599.73, "discounted_cash": 7559.84, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1343.57, "10th_percentile": 744.66, "90th_percentile": 1670.69, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "1 through 10", "median_amount": 3286.28, "10th_percentile": 2298.20, "90th_percentile": 4882.85, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 2491.80, "10th_percentile": 1287.89, "90th_percentile": 3956.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2795.28, "10th_percentile": 2795.28, "90th_percentile": 2795.28, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 490.49, "10th_percentile": 201.30, "90th_percentile": 703.52, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "1 through 10", "median_amount": 1145.07, "10th_percentile": 939.99, "90th_percentile": 1780.07, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1236.54, "10th_percentile": 745.57, "90th_percentile": 1703.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 896.45, "10th_percentile": 783.14, "90th_percentile": 1136.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1762.56, "10th_percentile": 1762.56, "90th_percentile": 1762.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1762.56, "10th_percentile": 1762.56, "90th_percentile": 1762.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 697.07, "10th_percentile": 697.07, "90th_percentile": 697.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w balloon dilate", "code_information": [ { "code": "45386", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1470.00, "discounted_cash": 882.00, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/balloon dilat", "code_information": [ { "code": "45386", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1470.00, "discounted_cash": 882.00, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/endoscope us", "code_information": [ { "code": "45391", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 1048.80, "maximum": 3075.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy flex w decomp", "code_information": [ { "code": "45393", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 925.25, "discounted_cash": 555.15, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/decompression", "code_information": [ { "code": "45393", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 925.25, "discounted_cash": 555.15, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/band ligation", "code_information": [ { "code": "45398", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9366.25, "discounted_cash": 5619.75, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surg dx exam anorectal", "code_information": [ { "code": "45990", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 2439.38, "maximum": 7152.07, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I&d perirectal or ischial abs", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3984.75, "discounted_cash": 2390.85, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3586.28, "10th_percentile": 3586.28, "90th_percentile": 3586.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3586.28, "10th_percentile": 3586.28, "90th_percentile": 3586.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of rectal abscess", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3984.75, "discounted_cash": 2390.85, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3586.28, "10th_percentile": 3586.28, "90th_percentile": 3586.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 3586.28, "10th_percentile": 3586.28, "90th_percentile": 3586.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I&d perianal abscess", "code_information": [ { "code": "46050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3049.75, "discounted_cash": 1829.85, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of anal abscess", "code_information": [ { "code": "46050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3049.75, "discounted_cash": 1829.85, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of rectal abscess", "code_information": [ { "code": "46060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35125.50, "discounted_cash": 21075.30, "minimum": 2439.38, "maximum": 7152.07, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inc thrombosed hemorrhoid ext", "code_information": [ { "code": "46083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.75, "discounted_cash": 613.65, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incise external hemorrhoid", "code_information": [ { "code": "46083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.75, "discounted_cash": 613.65, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ligation of hemorrhoid(s)", "code_information": [ { "code": "46221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11656.50, "discounted_cash": 6993.90, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 453.40, "10th_percentile": 453.40, "90th_percentile": 453.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemorrhoidectomy int ext sing", "code_information": [ { "code": "46255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1044.75, "discounted_cash": 626.85, "minimum": 2439.38, "maximum": 7152.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove int/ext hem 1 group", "code_information": [ { "code": "46255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1044.75, "discounted_cash": 626.85, "minimum": 2439.38, "maximum": 7152.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemorrhoidectomy int & ext", "code_information": [ { "code": "46260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1289.50, "discounted_cash": 773.70, "minimum": 2439.38, "maximum": 7152.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove in/ex hem groups 2+", "code_information": [ { "code": "46260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1289.50, "discounted_cash": 773.70, "minimum": 2439.38, "maximum": 7152.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove anal fist subq", "code_information": [ { "code": "46270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 834.75, "discounted_cash": 500.85, "minimum": 2439.38, "maximum": 7152.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thrombosed hemorrhoid ext", "code_information": [ { "code": "46320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 472.50, "discounted_cash": 283.50, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of hemorrhoid clot", "code_information": [ { "code": "46320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 472.50, "discounted_cash": 283.50, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic anoscopy spx", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 114.66, "maximum": 336.17, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic anoscopy spx", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3550.00, "discounted_cash": 2130.00, "minimum": 114.66, "maximum": 336.17, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic anoscopy", "code_information": [ { "code": "46601", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16324.83, "discounted_cash": 9794.90, "minimum": 354.95, "maximum": 1040.68, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anoscopy and biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1847.75, "discounted_cash": 1108.65, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anoscopy w biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1847.75, "discounted_cash": 1108.65, "minimum": 1048.80, "maximum": 3075.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3075.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1048.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy anal lesion simple exc", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 635.75, "discounted_cash": 381.45, "minimum": 2439.38, "maximum": 7152.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of anal lesion(s)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 635.75, "discounted_cash": 381.45, "minimum": 2439.38, "maximum": 7152.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 7152.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2439.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy liver wedge", "code_information": [ { "code": "47100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1922.25, "discounted_cash": 1153.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wedge biopsy of liver", "code_information": [ { "code": "47100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1922.25, "discounted_cash": 1153.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscope proc liver", "code_information": [ { "code": "47379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 753.25, "discounted_cash": 451.95, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscope procedure liver", "code_information": [ { "code": "47379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 753.25, "discounted_cash": 451.95, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopic cholecystectomy", "code_information": [ { "code": "47562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69238.86, "discounted_cash": 41543.32, "minimum": 5189.72, "maximum": 15215.83, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3266.61, "10th_percentile": 2926.39, "90th_percentile": 3606.82, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "13", "median_amount": 10866.35, "10th_percentile": 8082.52, "90th_percentile": 12669.76, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "1 through 10", "median_amount": 9145.89, "10th_percentile": 9145.89, "90th_percentile": 9145.89, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 436.53, "10th_percentile": 436.53, "90th_percentile": 436.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1283.96, "10th_percentile": 821.10, "90th_percentile": 1407.71, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3269.97, "10th_percentile": 3269.97, "90th_percentile": 3269.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4100.40, "10th_percentile": 3444.34, "90th_percentile": 4255.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopic cholecystectomy", "code_information": [ { "code": "47562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27484.19, "discounted_cash": 16490.51, "minimum": 5189.72, "maximum": 15215.83, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3266.61, "10th_percentile": 2926.39, "90th_percentile": 3606.82, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "13", "median_amount": 10866.35, "10th_percentile": 8082.52, "90th_percentile": 12669.76, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "1 through 10", "median_amount": 9145.89, "10th_percentile": 9145.89, "90th_percentile": 9145.89, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 436.53, "10th_percentile": 436.53, "90th_percentile": 436.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1283.96, "10th_percentile": 821.10, "90th_percentile": 1407.71, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3269.97, "10th_percentile": 3269.97, "90th_percentile": 3269.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4100.40, "10th_percentile": 3444.34, "90th_percentile": 4255.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparo cholecystectomy/explr", "code_information": [ { "code": "47564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69238.86, "discounted_cash": 41543.32, "minimum": 9260.87, "maximum": 27152.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 27152.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 27152.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 9260.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cholectstectomy", "code_information": [ { "code": "47600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3038.50, "discounted_cash": 1823.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of gallbladder", "code_information": [ { "code": "47600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10379.87, "discounted_cash": 6227.92, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of gallbladder", "code_information": [ { "code": "47600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3038.50, "discounted_cash": 1823.10, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cholecystectomy w exp common", "code_information": [ { "code": "47610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2915.75, "discounted_cash": 1749.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of gallbladder", "code_information": [ { "code": "47610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10379.87, "discounted_cash": 6227.92, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of gallbladder", "code_information": [ { "code": "47610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2915.75, "discounted_cash": 1749.45, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of gallbladder", "code_information": [ { "code": "47612", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10379.87, "discounted_cash": 6227.92, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of gallbladder", "code_information": [ { "code": "47620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10379.87, "discounted_cash": 6227.92, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bile tract surgery procedure", "code_information": [ { "code": "47999", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31267.66, "discounted_cash": 18760.60, "minimum": 833.97, "maximum": 2445.13, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exploration of abdomen", "code_information": [ { "code": "49000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1777.50, "discounted_cash": 1066.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exploratory laparotomy abdomen", "code_information": [ { "code": "49000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1777.50, "discounted_cash": 1066.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage abdom abscess open", "code_information": [ { "code": "49020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4009.75, "discounted_cash": 2405.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage abscess open", "code_information": [ { "code": "49020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4009.75, "discounted_cash": 2405.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abd paracentesis", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5317.78, "discounted_cash": 3190.67, "minimum": 833.97, "maximum": 2445.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1880.68, "10th_percentile": 1880.68, "90th_percentile": 1880.68, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 566.85, "10th_percentile": 566.85, "90th_percentile": 873.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.53, "10th_percentile": 125.53, "90th_percentile": 125.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abd paracentesis w/imaging", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2275.50, "discounted_cash": 1365.30, "minimum": 833.97, "maximum": 2445.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abdominal paracentesis w image", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2275.50, "discounted_cash": 1365.30, "minimum": 833.97, "maximum": 2445.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2445.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 833.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise sacral spine tumor", "code_information": [ { "code": "49215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24325.45, "discounted_cash": 14595.27, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of omentum", "code_information": [ { "code": "49255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24325.45, "discounted_cash": 14595.27, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Image cath fluid peri/retro", "code_information": [ { "code": "49406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24338.09, "discounted_cash": 14602.85, "minimum": 1441.22, "maximum": 4225.54, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr ing hernia init reduce", "code_information": [ { "code": "49500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 427.50, "discounted_cash": 256.50, "minimum": 5550.31, "maximum": 16273.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5550.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init reduc >5 yr", "code_information": [ { "code": "49505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28913.14, "discounted_cash": 17347.88, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2128.86, "10th_percentile": 2128.86, "90th_percentile": 2128.86, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init reduc >5 yr", "code_information": [ { "code": "49505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26368.21, "discounted_cash": 15820.93, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4813.45, "10th_percentile": 4813.45, "90th_percentile": 4813.45, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "1 through 10", "median_amount": 10095.48, "10th_percentile": 10095.48, "90th_percentile": 10095.48, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init reduc >5 yr", "code_information": [ { "code": "49505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28913.14, "discounted_cash": 17347.88, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2324.14, "10th_percentile": 2324.14, "90th_percentile": 2324.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "1 through 10", "median_amount": 3119.89, "10th_percentile": 3119.89, "90th_percentile": 3119.89, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init block >5 yr", "code_information": [ { "code": "49507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38682.85, "discounted_cash": 23209.71, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init block >5 yr", "code_information": [ { "code": "49507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38682.85, "discounted_cash": 23209.71, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rerepair ing hernia reduce", "code_information": [ { "code": "49520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31122.29, "discounted_cash": 18673.37, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rerepair ing hernia reduce", "code_information": [ { "code": "49520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31122.29, "discounted_cash": 18673.37, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "1 through 10", "median_amount": 3531.49, "10th_percentile": 3531.49, "90th_percentile": 3531.49, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair 1st femoral hernia", "code_information": [ { "code": "49550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1916.00, "discounted_cash": 1149.60, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr rem hernia init reduce", "code_information": [ { "code": "49550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1916.00, "discounted_cash": 1149.60, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st < 3 cm rdc", "code_information": [ { "code": "49591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24152.13, "discounted_cash": 14491.28, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "1 through 10", "median_amount": 5962.99, "10th_percentile": 5238.65, "90th_percentile": 6687.33, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2350.68, "10th_percentile": 2350.68, "90th_percentile": 2350.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st < 3 ncr/strn", "code_information": [ { "code": "49592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23015.24, "discounted_cash": 13809.14, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2350.68, "10th_percentile": 2350.68, "90th_percentile": 2350.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st 3-10 rdc", "code_information": [ { "code": "49593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 34171.55, "discounted_cash": 20502.93, "minimum": 5550.31, "maximum": 16273.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16273.07, "count": "1 through 10", "median_amount": 10451.40, "10th_percentile": 10451.40, "90th_percentile": 10451.40, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5550.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st 3-10 ncr/strn", "code_information": [ { "code": "49594", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28696.91, "discounted_cash": 17218.15, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2584.35, "10th_percentile": 2584.35, "90th_percentile": 2584.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st > 10 rdc", "code_information": [ { "code": "49595", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59866.29, "discounted_cash": 35919.77, "minimum": 5550.31, "maximum": 16273.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5550.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair umbilical lesion", "code_information": [ { "code": "49605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43110.83, "discounted_cash": 25866.50, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair umbilical lesion", "code_information": [ { "code": "49606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43110.83, "discounted_cash": 25866.50, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn rcr 3-10 rdc", "code_information": [ { "code": "49615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1847.75, "discounted_cash": 1108.65, "minimum": 5550.31, "maximum": 16273.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16273.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5550.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn rcr > 10 rdc", "code_information": [ { "code": "49617", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 51149.87, "discounted_cash": 30689.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Omental flap intra-abdom", "code_information": [ { "code": "49905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48015.58, "discounted_cash": 28809.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Close nephrovisceral fistula", "code_information": [ { "code": "50526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31267.66, "discounted_cash": 18760.60, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspiration bladder insert cath", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6880.50, "discounted_cash": 4128.30, "minimum": 1822.17, "maximum": 5342.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1822.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain bl w/cath insertion", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6880.50, "discounted_cash": 4128.30, "minimum": 1822.17, "maximum": 5342.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1822.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bladder irrigation", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.75, "discounted_cash": 613.65, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "1 through 10", "median_amount": 819.50, "10th_percentile": 819.50, "90th_percentile": 819.50, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.63, "10th_percentile": 105.52, "90th_percentile": 109.73, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "1 through 10", "median_amount": 298.92, "10th_percentile": 298.92, "90th_percentile": 298.92, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Irrigation of bladder", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.75, "discounted_cash": 613.65, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "1 through 10", "median_amount": 819.50, "10th_percentile": 819.50, "90th_percentile": 819.50, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.63, "10th_percentile": 105.52, "90th_percentile": 109.73, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "1 through 10", "median_amount": 298.92, "10th_percentile": 298.92, "90th_percentile": 298.92, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert bladder catheter", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.40, "10th_percentile": 125.40, "90th_percentile": 125.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insertion straight catheter", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.40, "10th_percentile": 125.40, "90th_percentile": 125.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert temp bladder cath", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23476.06, "discounted_cash": 14085.64, "minimum": 114.66, "maximum": 336.17, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.95, "10th_percentile": 127.95, "90th_percentile": 131.81, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 357.06, "10th_percentile": 349.23, "90th_percentile": 363.19, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 326.83, "10th_percentile": 286.40, "90th_percentile": 395.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 494.59, "10th_percentile": 339.24, "90th_percentile": 649.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 44.49, "10th_percentile": 42.48, "90th_percentile": 46.74, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 126.67, "10th_percentile": 126.67, "90th_percentile": 131.77, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.04, "10th_percentile": 131.97, "90th_percentile": 134.12, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.40, "10th_percentile": 22.93, "90th_percentile": 131.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.91, "10th_percentile": 117.91, "90th_percentile": 117.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert temp bladder cath", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.95, "10th_percentile": 127.95, "90th_percentile": 131.81, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 357.06, "10th_percentile": 349.23, "90th_percentile": 363.19, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 326.83, "10th_percentile": 286.40, "90th_percentile": 395.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 494.59, "10th_percentile": 339.24, "90th_percentile": 649.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 44.49, "10th_percentile": 42.48, "90th_percentile": 46.74, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 126.67, "10th_percentile": 126.67, "90th_percentile": 131.77, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.04, "10th_percentile": 131.97, "90th_percentile": 134.12, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.40, "10th_percentile": 22.93, "90th_percentile": 131.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.91, "10th_percentile": 117.91, "90th_percentile": 117.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Catheter complicated", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 537.00, "discounted_cash": 322.20, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert bladder cath complex", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23476.06, "discounted_cash": 14085.64, "minimum": 139.17, "maximum": 408.04, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert bladder cath complex", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 537.00, "discounted_cash": 322.20, "minimum": 139.17, "maximum": 408.04, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Change of bladder tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.75, "discounted_cash": 613.65, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bladder scan", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.07, "10th_percentile": 51.04, "90th_percentile": 61.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.87, "10th_percentile": 64.00, "90th_percentile": 170.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 21.96, "10th_percentile": 20.67, "90th_percentile": 22.29, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.46, "10th_percentile": 62.21, "90th_percentile": 64.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 197.14, "10th_percentile": 197.14, "90th_percentile": 197.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 197.14, "10th_percentile": 197.14, "90th_percentile": 197.14, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us urine capacity measure", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.07, "10th_percentile": 51.04, "90th_percentile": 61.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.87, "10th_percentile": 64.00, "90th_percentile": 170.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 21.96, "10th_percentile": 20.67, "90th_percentile": 22.29, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.46, "10th_percentile": 62.21, "90th_percentile": 64.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 197.14, "10th_percentile": 197.14, "90th_percentile": 197.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 197.14, "10th_percentile": 197.14, "90th_percentile": 197.14, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Repair of bladder wound", "code_information": [ { "code": "51860", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24193.00, "discounted_cash": 14515.80, "minimum": 8225.42, "maximum": 24116.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 24116.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 24116.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 8225.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Circumcision w/regionl block", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9691.10, "discounted_cash": 5814.66, "minimum": 1822.17, "maximum": 5342.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1822.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Circum 28 days or older", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 572.25, "discounted_cash": 343.35, "minimum": 1822.17, "maximum": 5342.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1822.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair corporeal tear", "code_information": [ { "code": "54437", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9155.25, "discounted_cash": 5493.15, "minimum": 3067.89, "maximum": 8994.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8994.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8994.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3067.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Preputial stretching", "code_information": [ { "code": "54450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.25, "discounted_cash": 111.15, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Preputial stretching foreskin", "code_information": [ { "code": "54450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.25, "discounted_cash": 111.15, "minimum": 216.34, "maximum": 634.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 634.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 216.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise ep testis lesion", "code_information": [ { "code": "54512", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5009.25, "discounted_cash": 3005.55, "minimum": 3067.89, "maximum": 8994.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8994.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8994.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3067.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise lesion testis", "code_information": [ { "code": "54512", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5009.25, "discounted_cash": 3005.55, "minimum": 3067.89, "maximum": 8994.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8994.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8994.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3067.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exploration for testis", "code_information": [ { "code": "54550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9086.00, "discounted_cash": 5451.60, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exploration of testis", "code_information": [ { "code": "54550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9086.00, "discounted_cash": 5451.60, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc hydrocele uni", "code_information": [ { "code": "55040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15046.50, "discounted_cash": 9027.90, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of hydrocele", "code_information": [ { "code": "55040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15046.50, "discounted_cash": 9027.90, "minimum": 3139.13, "maximum": 9203.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9203.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3139.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of sperm duct(s)", "code_information": [ { "code": "55250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12748.06, "discounted_cash": 7648.84, "minimum": 1822.17, "maximum": 5342.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5342.45, "count": "1 through 10", "median_amount": 6976.02, "10th_percentile": 6976.02, "90th_percentile": 6976.02, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5342.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1822.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d of vulva/perineum", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 398.00, "discounted_cash": 238.80, "minimum": 270.58, "maximum": 793.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 793.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 793.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 270.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d vulva perineum abscess", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 398.00, "discounted_cash": 238.80, "minimum": 270.58, "maximum": 793.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 793.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 793.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 270.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of gland abscess", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 593.75, "discounted_cash": 356.25, "minimum": 178.94, "maximum": 524.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 524.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 524.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 178.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Id bartholin's gland abscess", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 593.75, "discounted_cash": 356.25, "minimum": 178.94, "maximum": 524.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 524.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 524.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 178.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hysterectomy", "code_information": [ { "code": "58150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hysterectomy", "code_information": [ { "code": "58152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial hysterectomy", "code_information": [ { "code": "58180", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extensive hysterectomy", "code_information": [ { "code": "58200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extensive hysterectomy", "code_information": [ { "code": "58210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of pelvis contents", "code_information": [ { "code": "58240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Division of fallopian tube", "code_information": [ { "code": "58600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6328.50, "discounted_cash": 3797.10, "minimum": 2828.22, "maximum": 8292.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2828.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ligate fallop tube abd or vag", "code_information": [ { "code": "58600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6328.50, "discounted_cash": 3797.10, "minimum": 2828.22, "maximum": 8292.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2828.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopy lysis", "code_information": [ { "code": "58660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1504.50, "discounted_cash": 902.70, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap w lysis of adhesions", "code_information": [ { "code": "58660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1504.50, "discounted_cash": 902.70, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopy tubal cautery", "code_information": [ { "code": "58670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25707.43, "discounted_cash": 15424.46, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lap w plmt occlusion device ov", "code_information": [ { "code": "58671", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 806.75, "discounted_cash": 484.05, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopy tubal block", "code_information": [ { "code": "58671", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 806.75, "discounted_cash": 484.05, "minimum": 5189.72, "maximum": 15215.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15215.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5189.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of ovary/tube(s)", "code_information": [ { "code": "58720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of ovary(s)", "code_information": [ { "code": "58940", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of ovary(s)", "code_information": [ { "code": "58943", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect ovarian malignancy", "code_information": [ { "code": "58950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect ovarian malignancy", "code_information": [ { "code": "58951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect ovarian malignancy", "code_information": [ { "code": "58952", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tah rad dissect for debulk", "code_information": [ { "code": "58953", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tah rad debulk/lymph remove", "code_information": [ { "code": "58954", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bso omentectomy w/tah", "code_information": [ { "code": "58956", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resect recur gyn mal w/lym", "code_information": [ { "code": "58958", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surgical trmt etopic pregnancy", "code_information": [ { "code": "59120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ectopic pregnancy", "code_information": [ { "code": "59120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44770.57, "discounted_cash": 26862.34, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ectopic pregnancy", "code_information": [ { "code": "59120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Obstetrical care", "code_information": [ { "code": "59409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10081.50, "discounted_cash": 6048.90, "minimum": 2828.22, "maximum": 8292.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2828.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaginal delivery only", "code_information": [ { "code": "59409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10081.50, "discounted_cash": 6048.90, "minimum": 2828.22, "maximum": 8292.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2828.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deliver placenta", "code_information": [ { "code": "59414", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10081.50, "discounted_cash": 6048.90, "minimum": 2828.22, "maximum": 8292.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8292.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2828.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy of thyroid", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.75, "discounted_cash": 108.45, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy thyroid perc core ndle", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.75, "discounted_cash": 108.45, "minimum": 625.85, "maximum": 1834.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1834.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 625.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain spinal cord cyst", "code_information": [ { "code": "62268", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perc aspir spinal cord cyst", "code_information": [ { "code": "62268", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx lmbr spi pnxr", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2440.25, "discounted_cash": 1464.15, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spinal puncture lumbar dx", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2440.25, "discounted_cash": 1464.15, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj epidural bld or clot patch", "code_information": [ { "code": "62273", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject epidural patch", "code_information": [ { "code": "62273", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Percutaneous diskectomy", "code_information": [ { "code": "62287", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8304.25, "discounted_cash": 4982.55, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj proc discography lumbar ea", "code_information": [ { "code": "62290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 844.50, "discounted_cash": 506.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx px discography lumbar", "code_information": [ { "code": "62290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 844.50, "discounted_cash": 506.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj spine cerv thor wo imaging", "code_information": [ { "code": "62320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar crv/thrc", "code_information": [ { "code": "62320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar crv/thrc", "code_information": [ { "code": "62321", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4284.27, "discounted_cash": 2570.56, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "1 through 10", "median_amount": 2279.51, "10th_percentile": 1713.14, "90th_percentile": 2433.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 373.02, "10th_percentile": 253.04, "90th_percentile": 389.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 308.34, "10th_percentile": 298.54, "90th_percentile": 319.15, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 547.48, "10th_percentile": 521.37, "90th_percentile": 736.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj spine l/s wo imaging", "code_information": [ { "code": "62322", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar lmbr/sac", "code_information": [ { "code": "62322", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar lmbr/sac", "code_information": [ { "code": "62323", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4222.78, "discounted_cash": 2533.67, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 869.71, "10th_percentile": 869.71, "90th_percentile": 869.71, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 479.30, "10th_percentile": 448.05, "90th_percentile": 519.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 308.34, "10th_percentile": 139.88, "90th_percentile": 308.34, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "1 through 10", "median_amount": 921.78, "10th_percentile": 921.78, "90th_percentile": 921.78, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 821.23, "10th_percentile": 821.23, "90th_percentile": 821.23, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 797.47, "10th_percentile": 781.89, "90th_percentile": 813.05, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Perc lumbar decomp lf removal", "code_information": [ { "code": "62330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35496.15, "discounted_cash": 21297.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10513.73, "10th_percentile": 10513.73, "90th_percentile": 10513.73, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Analyze spine infus pump", "code_information": [ { "code": "62367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.50, "discounted_cash": 774.90, "minimum": 266.77, "maximum": 782.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 266.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Analyze implanted pump", "code_information": [ { "code": "62368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.50, "discounted_cash": 774.90, "minimum": 266.77, "maximum": 782.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 266.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Analyze sp inf pump w/reprog", "code_information": [ { "code": "62368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.50, "discounted_cash": 774.90, "minimum": 266.77, "maximum": 782.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 266.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anal sp inf pmp w/reprg&fill", "code_information": [ { "code": "62369", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.50, "discounted_cash": 774.90, "minimum": 266.77, "maximum": 782.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 266.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Analysis imp pump w reprg fill", "code_information": [ { "code": "62369", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.50, "discounted_cash": 774.90, "minimum": 266.77, "maximum": 782.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 266.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Analysis imp pump reprg fill", "code_information": [ { "code": "62370", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.50, "discounted_cash": 774.90, "minimum": 266.77, "maximum": 782.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 266.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anl sp inf pmp w/mdreprg&fil", "code_information": [ { "code": "62370", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1291.50, "discounted_cash": 774.90, "minimum": 266.77, "maximum": 782.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 782.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 266.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spine lamina 1-2 vert", "code_information": [ { "code": "63005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spine lamina 1/2 lmbr", "code_information": [ { "code": "63005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29622.00, "discounted_cash": 17773.20, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Low back disk surgery", "code_information": [ { "code": "63030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44451.17, "discounted_cash": 26670.70, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Low back disk surgery", "code_information": [ { "code": "63030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44451.17, "discounted_cash": 26670.70, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lam facetec & foramot thrc", "code_information": [ { "code": "63046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18533.00, "discounted_cash": 11119.80, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "1 through 10", "median_amount": 5687.78, "10th_percentile": 5687.78, "90th_percentile": 5687.78, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spine lamina 1 thrc", "code_information": [ { "code": "63046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18533.00, "discounted_cash": 11119.80, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "1 through 10", "median_amount": 5687.78, "10th_percentile": 5687.78, "90th_percentile": 5687.78, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spine lamina 1 lmbr", "code_information": [ { "code": "63047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45607.85, "discounted_cash": 27364.71, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1910.51, "10th_percentile": 382.11, "90th_percentile": 3438.91, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spinal lamina add-on", "code_information": [ { "code": "63048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47714.79, "discounted_cash": 28628.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise intrspinl lesion lmbr", "code_information": [ { "code": "63267", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19161.91, "discounted_cash": 11497.15, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Implant neuroelectrodes", "code_information": [ { "code": "63650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 34341.54, "discounted_cash": 20604.92, "minimum": 5837.76, "maximum": 17115.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 17115.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 17115.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5837.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6642.21, "10th_percentile": 6642.21, "90th_percentile": 6642.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Implant neuroelectrodes", "code_information": [ { "code": "63655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 72410.25, "discounted_cash": 43446.15, "minimum": 19074.98, "maximum": 55926.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 55926.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 55926.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61353.24, "10th_percentile": 61353.24, "90th_percentile": 61353.24, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19074.98, "count": "1 through 10", "median_amount": 22222.71, "10th_percentile": 22222.71, "90th_percentile": 22222.71, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laminectomy implant stimulator", "code_information": [ { "code": "63655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 72410.25, "discounted_cash": 43446.15, "minimum": 19074.98, "maximum": 55926.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 55926.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 55926.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61353.24, "10th_percentile": 61353.24, "90th_percentile": 61353.24, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19074.98, "count": "1 through 10", "median_amount": 22222.71, "10th_percentile": 22222.71, "90th_percentile": 22222.71, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spine eltrd perq aray", "code_information": [ { "code": "63661", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28630.66, "discounted_cash": 17178.40, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3390.56, "10th_percentile": 3390.56, "90th_percentile": 3390.56, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spine eltrd plate", "code_information": [ { "code": "63662", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8304.25, "discounted_cash": 4982.55, "minimum": 3059.03, "maximum": 8968.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8968.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8968.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3059.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise spine eltrd perq aray", "code_information": [ { "code": "63663", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21863.75, "discounted_cash": 13118.25, "minimum": 5837.76, "maximum": 17115.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 17115.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 17115.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5837.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise spine eltrd plate", "code_information": [ { "code": "63664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 175226.70, "discounted_cash": 105136.02, "minimum": 11092.45, "maximum": 32522.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 32522.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 32522.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11092.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insrt/redo spine n generator", "code_information": [ { "code": "63685", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 123687.69, "discounted_cash": 74212.61, "minimum": 27106.54, "maximum": 79474.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16183.09, "10th_percentile": 16183.09, "90th_percentile": 16183.09, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 79474.17, "count": "1 through 10", "median_amount": 41612.46, "10th_percentile": 41612.46, "90th_percentile": 41612.46, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 79474.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5359.55, "10th_percentile": 1306.91, "90th_percentile": 5547.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27106.54, "count": "1 through 10", "median_amount": 16021.26, "10th_percentile": 16021.26, "90th_percentile": 16021.26, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13922.07, "10th_percentile": 13922.07, "90th_percentile": 13922.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17749.19, "10th_percentile": 17749.19, "90th_percentile": 17749.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise/remove neuroreceiver", "code_information": [ { "code": "63688", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44176.68, "discounted_cash": 26506.01, "minimum": 3059.03, "maximum": 8968.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 8968.83, "count": "1 through 10", "median_amount": 8981.94, "10th_percentile": 8981.94, "90th_percentile": 8981.94, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 8968.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3059.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2118.05, "10th_percentile": 2118.05, "90th_percentile": 2118.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj anesth trigeminal nerve", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd trigeminal nrv", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bil inj anesth trigeminal nerv", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2471.50, "discounted_cash": 1482.90, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj anes greater occipital nrv", "code_information": [ { "code": "64405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.22, "10th_percentile": 51.08, "90th_percentile": 113.35, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd gr ocpl nrv", "code_information": [ { "code": "64405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1236.00, "discounted_cash": 741.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.22, "10th_percentile": 51.08, "90th_percentile": 113.35, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd brach plexus", "code_information": [ { "code": "64415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 51075.74, "discounted_cash": 30645.44, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd brach plexus", "code_information": [ { "code": "64415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46412.10, "discounted_cash": 27847.26, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.39, "10th_percentile": 124.39, "90th_percentile": 124.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "1 through 10", "median_amount": 3119.82, "10th_percentile": 3119.82, "90th_percentile": 3119.82, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd brach plexus", "code_information": [ { "code": "64415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56018.33, "discounted_cash": 33611.00, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1206.99, "10th_percentile": 1206.99, "90th_percentile": 1206.99, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4266.41, "10th_percentile": 4266.41, "90th_percentile": 4266.41, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1944.30, "10th_percentile": 1944.30, "90th_percentile": 1944.30, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj anest agent anxillary nrve", "code_information": [ { "code": "64417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd axillary nrv", "code_information": [ { "code": "64417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anes inj suprascapular nerve", "code_information": [ { "code": "64418", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.75, "discounted_cash": 78.45, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd sprscap nrv", "code_information": [ { "code": "64418", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.75, "discounted_cash": 78.45, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj aa or strd intercostal ner", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd ntrcost nrv 1", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj anes intercost nrv mult", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd ntrcost nrv ea", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerv blk ilioing iliohypogastr", "code_information": [ { "code": "64425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd ii ih nerves", "code_information": [ { "code": "64425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd sciatic nerve", "code_information": [ { "code": "64445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31876.21, "discounted_cash": 19125.73, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd sciatic nerve", "code_information": [ { "code": "64445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31876.21, "discounted_cash": 19125.73, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd femoral nerve", "code_information": [ { "code": "64447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82988.21, "discounted_cash": 49792.93, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd femoral nerve", "code_information": [ { "code": "64447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 86503.88, "discounted_cash": 51902.33, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd femoral nerve", "code_information": [ { "code": "64447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81313.48, "discounted_cash": 48788.09, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1958.23, "10th_percentile": 1958.23, "90th_percentile": 1958.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4287.23, "10th_percentile": 4287.23, "90th_percentile": 4287.23, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5037.98, "10th_percentile": 5037.98, "90th_percentile": 5037.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj aa lumbar plexus", "code_information": [ { "code": "64449", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2349.00, "discounted_cash": 1409.40, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd lmbr plex nfs", "code_information": [ { "code": "64449", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2349.00, "discounted_cash": 1409.40, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd other pn/branch", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75619.65, "discounted_cash": 45371.79, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.08, "10th_percentile": 17.08, "90th_percentile": 17.08, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd other pn/branch", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80745.03, "discounted_cash": 48447.02, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5359.04, "10th_percentile": 5359.04, "90th_percentile": 5359.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd other pn/branch", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60944.04, "discounted_cash": 36566.42, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "1 through 10", "median_amount": 2406.53, "10th_percentile": 2406.53, "90th_percentile": 2406.53, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5997.60, "10th_percentile": 5997.60, "90th_percentile": 5997.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj genicular nerve block w/img", "code_information": [ { "code": "64454", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4220.61, "discounted_cash": 2532.37, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj genicular nerve block w/img", "code_information": [ { "code": "64454", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4220.61, "discounted_cash": 2532.37, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 695.16, "10th_percentile": 695.16, "90th_percentile": 695.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pvb thoracic single inj site", "code_information": [ { "code": "64461", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pvb thoracic 2nd+ inj site", "code_information": [ { "code": "64462", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.00, "discounted_cash": 1801.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pvb thoracic cont inf", "code_information": [ { "code": "64463", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pvb thoracic cont infusion", "code_information": [ { "code": "64463", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural c/t", "code_information": [ { "code": "64479", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj tfrm epidrl c/t 1 level", "code_information": [ { "code": "64479", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bil inj tfrm epidrl ct 1 level", "code_information": [ { "code": "64479", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7786.50, "discounted_cash": 4671.90, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epdrl c/t adl", "code_information": [ { "code": "64480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.50, "discounted_cash": 187.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural add-on", "code_information": [ { "code": "64480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.50, "discounted_cash": 187.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bil inj foramen epdrl c/t adl", "code_information": [ { "code": "64480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 624.50, "discounted_cash": 374.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5010.93, "discounted_cash": 3006.56, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1206.99, "10th_percentile": 1206.99, "90th_percentile": 1206.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 399.72, "10th_percentile": 96.97, "90th_percentile": 799.40, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 713.72, "10th_percentile": 713.72, "90th_percentile": 713.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8945.76, "discounted_cash": 5367.46, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2381.97, "10th_percentile": 2381.97, "90th_percentile": 2381.97, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "1 through 10", "median_amount": 5568.68, "10th_percentile": 5049.40, "90th_percentile": 6076.65, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1894.61, "10th_percentile": 1822.60, "90th_percentile": 2136.39, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1821.95, "10th_percentile": 1821.95, "90th_percentile": 1821.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1802.27, "10th_percentile": 1802.27, "90th_percentile": 1802.27, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1419.33, "10th_percentile": 1419.33, "90th_percentile": 2117.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1058.97, "10th_percentile": 358.40, "90th_percentile": 1217.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2569.17, "10th_percentile": 2329.17, "90th_percentile": 2809.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2569.17, "10th_percentile": 2329.17, "90th_percentile": 2809.17, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5098.78, "discounted_cash": 3059.27, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1149.48, "10th_percentile": 1149.48, "90th_percentile": 1149.48, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "1 through 10", "median_amount": 2620.73, "10th_percentile": 1290.44, "90th_percentile": 3090.44, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 780.92, "10th_percentile": 708.36, "90th_percentile": 806.81, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 901.19, "10th_percentile": 901.19, "90th_percentile": 901.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 788.55, "10th_percentile": 788.55, "90th_percentile": 788.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 745.95, "10th_percentile": 535.85, "90th_percentile": 956.05, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5073.61, "discounted_cash": 3044.17, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1128.67, "10th_percentile": 1001.41, "90th_percentile": 1145.32, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "1 through 10", "median_amount": 2509.59, "10th_percentile": 1114.05, "90th_percentile": 2673.44, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 812.73, "10th_percentile": 755.38, "90th_percentile": 861.60, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "1 through 10", "median_amount": 837.99, "10th_percentile": 837.99, "90th_percentile": 837.99, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 828.00, "10th_percentile": 709.71, "90th_percentile": 1039.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural add-on", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5249.13, "discounted_cash": 3149.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural add-on", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5249.13, "discounted_cash": 3149.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural add-on", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5223.63, "discounted_cash": 3134.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tap block unil by injection", "code_information": [ { "code": "64486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tap block uni by infusion", "code_information": [ { "code": "64487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 224.50, "discounted_cash": 134.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tap bil inj inc guidance", "code_information": [ { "code": "64488", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 247.50, "discounted_cash": 148.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tap block bi injection", "code_information": [ { "code": "64488", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 247.50, "discounted_cash": 148.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16565.13, "discounted_cash": 9939.08, "minimum": 791.92, "maximum": 2321.85, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 974.14, "10th_percentile": 974.14, "90th_percentile": 974.14, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10722.77, "discounted_cash": 6433.66, "minimum": 791.92, "maximum": 2321.85, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 974.14, "10th_percentile": 974.14, "90th_percentile": 974.14, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10722.77, "discounted_cash": 6433.66, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "1 through 10", "median_amount": 7182.54, "10th_percentile": 6054.52, "90th_percentile": 7707.54, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2851.60, "10th_percentile": 2721.22, "90th_percentile": 2887.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "1 through 10", "median_amount": 2612.02, "10th_percentile": 2612.02, "90th_percentile": 2612.02, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1921.71, "10th_percentile": 1921.71, "90th_percentile": 1921.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3072.41, "10th_percentile": 3072.41, "90th_percentile": 3072.41, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4884.44, "discounted_cash": 2930.66, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1206.95, "10th_percentile": 1206.95, "90th_percentile": 1206.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 592.84, "10th_percentile": 592.84, "90th_percentile": 592.84, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4688.94, "discounted_cash": 2813.36, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "1 through 10", "median_amount": 2694.68, "10th_percentile": 2694.68, "90th_percentile": 2694.68, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "1 through 10", "median_amount": 837.99, "10th_percentile": 837.99, "90th_percentile": 837.99, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 2 lev", "code_information": [ { "code": "64491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10787.80, "discounted_cash": 6472.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.97, "10th_percentile": 31.97, "90th_percentile": 31.97, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.06, "10th_percentile": 63.06, "90th_percentile": 63.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 2 lev", "code_information": [ { "code": "64491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10680.36, "discounted_cash": 6408.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.81, "10th_percentile": 100.81, "90th_percentile": 100.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 2 lev", "code_information": [ { "code": "64491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4884.44, "discounted_cash": 2930.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.29, "10th_percentile": 35.29, "90th_percentile": 35.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 2 lev", "code_information": [ { "code": "64491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4738.80, "discounted_cash": 2843.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 3 lev", "code_information": [ { "code": "64492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10468.77, "discounted_cash": 6281.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.64, "10th_percentile": 31.64, "90th_percentile": 31.64, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.79, "10th_percentile": 99.79, "90th_percentile": 99.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 3 lev", "code_information": [ { "code": "64492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10737.08, "discounted_cash": 6442.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 3 lev", "code_information": [ { "code": "64492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4884.44, "discounted_cash": 2930.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.93, "10th_percentile": 34.93, "90th_percentile": 34.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 3 lev", "code_information": [ { "code": "64492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4709.38, "discounted_cash": 2825.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10999.00, "discounted_cash": 6599.40, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 952.00, "10th_percentile": 879.49, "90th_percentile": 998.50, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10999.00, "discounted_cash": 6599.40, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2739.36, "10th_percentile": 2736.01, "90th_percentile": 2798.05, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "1 through 10", "median_amount": 7239.94, "10th_percentile": 6502.12, "90th_percentile": 7883.95, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 2824.98, "10th_percentile": 2412.23, "90th_percentile": 2951.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1504.28, "10th_percentile": 1504.28, "90th_percentile": 1504.28, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "1 through 10", "median_amount": 2612.02, "10th_percentile": 2517.66, "90th_percentile": 2864.53, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1921.71, "10th_percentile": 1647.18, "90th_percentile": 2277.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4966.34, "discounted_cash": 2979.80, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1218.18, "10th_percentile": 1218.18, "90th_percentile": 1218.18, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4840.50, "discounted_cash": 2904.30, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10215.59, "discounted_cash": 6129.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.15, "10th_percentile": 30.63, "90th_percentile": 34.77, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.11, "10th_percentile": 58.29, "90th_percentile": 65.93, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11042.50, "discounted_cash": 6625.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.46, "10th_percentile": 102.46, "90th_percentile": 102.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.59, "10th_percentile": 58.80, "90th_percentile": 85.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4966.34, "discounted_cash": 2979.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4825.00, "discounted_cash": 2895.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 3 lev", "code_information": [ { "code": "64495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10166.42, "discounted_cash": 6099.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.09, "10th_percentile": 33.09, "90th_percentile": 33.09, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 3 lev", "code_information": [ { "code": "64495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11230.73, "discounted_cash": 6738.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 3 lev", "code_information": [ { "code": "64495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4975.50, "discounted_cash": 2985.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 3 lev", "code_information": [ { "code": "64495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4725.50, "discounted_cash": 2835.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block spenopalatine gangl", "code_information": [ { "code": "64505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 891.75, "discounted_cash": 535.05, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block spenopalatine gangl", "code_information": [ { "code": "64505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 891.75, "discounted_cash": 535.05, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj anes stellate ganglion", "code_information": [ { "code": "64510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block stellate ganglion", "code_information": [ { "code": "64510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj anes agnt super hypogastri", "code_information": [ { "code": "64517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block inj hypogas plxs", "code_information": [ { "code": "64517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block lumbar/thoracic", "code_information": [ { "code": "64520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6405.00, "discounted_cash": 3843.00, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block lumbar/thoracic", "code_information": [ { "code": "64520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6405.00, "discounted_cash": 3843.00, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1059.03, "10th_percentile": 1059.03, "90th_percentile": 1059.03, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj anesth celiac plexus", "code_information": [ { "code": "64530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block inj celiac pelus", "code_information": [ { "code": "64530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv musc neck dyston", "code_information": [ { "code": "64616", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5798.00, "discounted_cash": 3478.80, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.81, "10th_percentile": 122.86, "90th_percentile": 136.74, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv musc neck dyston", "code_information": [ { "code": "64616", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5347.00, "discounted_cash": 3208.20, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv musc neck dyston", "code_information": [ { "code": "64616", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6687.70, "discounted_cash": 4012.62, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodener muscle larynx emg", "code_information": [ { "code": "64617", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17192.50, "discounted_cash": 10315.50, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodener muscle larynx emg", "code_information": [ { "code": "64617", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17192.50, "discounted_cash": 10315.50, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dstrj nulyt agt gnclr nrv", "code_information": [ { "code": "64624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14870.25, "discounted_cash": 8922.15, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dstrj nulyt agt gnclr nrv", "code_information": [ { "code": "64624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14870.25, "discounted_cash": 8922.15, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rf ablt j nrv nrvtg si jt", "code_information": [ { "code": "64625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8304.25, "discounted_cash": 4982.55, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rf abltj nrv nrvtg si jt", "code_information": [ { "code": "64625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8304.25, "discounted_cash": 4982.55, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trml dstrj ios bvn 1st 2 l/s", "code_information": [ { "code": "64628", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57385.57, "discounted_cash": 34431.34, "minimum": 11445.15, "maximum": 33556.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33556.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11445.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7969.89, "10th_percentile": 7969.89, "90th_percentile": 7969.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trml dstrj ios bvn ea addl", "code_information": [ { "code": "64629", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 417.50, "discounted_cash": 250.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy cerv/thor facet jnt", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15358.25, "discounted_cash": 9214.95, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 852.56, "10th_percentile": 852.56, "90th_percentile": 852.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy cerv/thor facet jnt", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25708.25, "discounted_cash": 15424.95, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy cerv/thor facet jnt", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15326.08, "discounted_cash": 9195.65, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2451.71, "10th_percentile": 2451.71, "90th_percentile": 2451.71, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "1 through 10", "median_amount": 2248.57, "10th_percentile": 2248.57, "90th_percentile": 2248.57, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2035.33, "10th_percentile": 1819.85, "90th_percentile": 2250.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy cerv/thor facet jnt", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15331.94, "discounted_cash": 9199.16, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "1 through 10", "median_amount": 2248.57, "10th_percentile": 2248.57, "90th_percentile": 2248.57, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1513.70, "10th_percentile": 1513.70, "90th_percentile": 2242.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2151.18, "10th_percentile": 2151.18, "90th_percentile": 2151.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy c/th facet jnt addl", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15112.75, "discounted_cash": 9067.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 239.09, "10th_percentile": 239.09, "90th_percentile": 239.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.14, "10th_percentile": 83.14, "90th_percentile": 83.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy c/th facet jnt addl", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25708.25, "discounted_cash": 15424.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy c/th facet jnt addl", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15363.15, "discounted_cash": 9217.89, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 203.28, "10th_percentile": 178.46, "90th_percentile": 228.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy c/th facet jnt addl", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15353.27, "discounted_cash": 9211.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 147.65, "10th_percentile": 147.65, "90th_percentile": 226.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 419.56, "10th_percentile": 419.56, "90th_percentile": 419.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy lumb/sac facet jnt", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14792.50, "discounted_cash": 8875.50, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 852.56, "10th_percentile": 806.07, "90th_percentile": 895.20, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy lumb/sac facet jnt", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30457.60, "discounted_cash": 18274.56, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy lumb/sac facet jnt", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15056.81, "discounted_cash": 9034.09, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2513.02, "10th_percentile": 2463.97, "90th_percentile": 2562.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "1 through 10", "median_amount": 6157.83, "10th_percentile": 3605.71, "90th_percentile": 6426.77, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4236.89, "10th_percentile": 4153.00, "90th_percentile": 4320.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2227.00, "10th_percentile": 1983.11, "90th_percentile": 2470.89, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2113.41, "10th_percentile": 1812.83, "90th_percentile": 2373.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2688.98, "10th_percentile": 2688.98, "90th_percentile": 2688.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 7285.54, "10th_percentile": 7285.54, "90th_percentile": 7285.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 7285.54, "10th_percentile": 7285.54, "90th_percentile": 7285.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Destroy lumb/sac facet jnt", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15104.19, "discounted_cash": 9062.51, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2316.89, "10th_percentile": 2110.95, "90th_percentile": 2522.83, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "1 through 10", "median_amount": 6169.14, "10th_percentile": 3667.62, "90th_percentile": 6744.63, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4341.74, "10th_percentile": 1165.59, "90th_percentile": 4389.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2222.49, "10th_percentile": 1982.21, "90th_percentile": 2462.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2113.41, "10th_percentile": 1812.83, "90th_percentile": 2373.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2210.71, "10th_percentile": 2210.71, "90th_percentile": 2210.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy l/s facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14829.31, "discounted_cash": 8897.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.20, "10th_percentile": 75.84, "90th_percentile": 84.22, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 252.96, "10th_percentile": 252.96, "90th_percentile": 252.96, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy l/s facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30457.60, "discounted_cash": 18274.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy l/s facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15078.52, "discounted_cash": 9047.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 236.41, "10th_percentile": 231.79, "90th_percentile": 241.03, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 211.50, "10th_percentile": 186.96, "90th_percentile": 236.05, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 180.82, "10th_percentile": 166.14, "90th_percentile": 226.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 685.37, "10th_percentile": 685.37, "90th_percentile": 685.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 685.37, "10th_percentile": 685.37, "90th_percentile": 685.37, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Destroy l/s facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15125.76, "discounted_cash": 9075.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 217.97, "10th_percentile": 198.59, "90th_percentile": 237.35, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 209.08, "10th_percentile": 186.47, "90th_percentile": 231.70, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 203.43, "10th_percentile": 185.34, "90th_percentile": 221.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destr w neuro periph nrv", "code_information": [ { "code": "64640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injection treatment of nerve", "code_information": [ { "code": "64640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3893.50, "discounted_cash": 2336.10, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bil destr w neuro periph nrv", "code_information": [ { "code": "64640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7786.50, "discounted_cash": 4671.90, "minimum": 791.92, "maximum": 2321.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2321.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 791.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv 1 extremity 1-4", "code_information": [ { "code": "64642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8038.19, "discounted_cash": 4822.91, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 252.01, "10th_percentile": 119.79, "90th_percentile": 274.65, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv 1 extremity 1-4", "code_information": [ { "code": "64642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8038.19, "discounted_cash": 4822.91, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "64643", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv 1 extrem 5/> mus", "code_information": [ { "code": "64644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.50, "discounted_cash": 1802.10, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neuroplasty; nerve of hand/ft", "code_information": [ { "code": "64704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 1260.00, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise hand/foot nerve", "code_information": [ { "code": "64704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 1260.00, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise ulnar nerve at elbow", "code_information": [ { "code": "64718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12735.20, "discounted_cash": 7641.12, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise ulnar nerve at elbow", "code_information": [ { "code": "64718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16061.75, "discounted_cash": 9637.05, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise ulnar nerve at elbow", "code_information": [ { "code": "64718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15611.45, "discounted_cash": 9366.87, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 7649.88, "10th_percentile": 7649.88, "90th_percentile": 7649.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 7649.88, "10th_percentile": 7649.88, "90th_percentile": 7649.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11752.87, "discounted_cash": 7051.72, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 813.81, "10th_percentile": 782.81, "90th_percentile": 844.81, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11578.67, "discounted_cash": 6947.20, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "1 through 10", "median_amount": 6654.23, "10th_percentile": 6654.23, "90th_percentile": 6654.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12277.61, "discounted_cash": 7366.57, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "1 through 10", "median_amount": 6157.83, "10th_percentile": 6157.83, "90th_percentile": 6157.83, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2206.79, "10th_percentile": 2206.79, "90th_percentile": 2206.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2059.46, "10th_percentile": 2059.46, "90th_percentile": 2059.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 7649.88, "10th_percentile": 7649.88, "90th_percentile": 7649.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 7649.88, "10th_percentile": 7649.88, "90th_percentile": 7649.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1913.14, "10th_percentile": 1913.14, "90th_percentile": 1913.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release foot/toe nerve", "code_information": [ { "code": "64726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22041.00, "discounted_cash": 13224.60, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release foot/toe nerve", "code_information": [ { "code": "64726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22041.00, "discounted_cash": 13224.60, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release foot/toe nerve", "code_information": [ { "code": "64726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22041.00, "discounted_cash": 13224.60, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nervous system surgery", "code_information": [ { "code": "64999", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 144.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Unlisted procedure nervous sys", "code_information": [ { "code": "64999", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 144.60, "minimum": 262.57, "maximum": 769.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 769.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 262.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rem fb conjunctiva superficial", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rem fb conjunctiva embedded", "code_information": [ { "code": "65210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rem fb coneal wo slit lamp", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.25, "discounted_cash": 625.95, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rem fb cornea w slit lamp", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Curette/treat cornea", "code_information": [ { "code": "65435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3830.00, "discounted_cash": 2298.00, "minimum": 861.53, "maximum": 2525.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2525.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2525.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 861.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal corneal epithelium", "code_information": [ { "code": "65435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3830.00, "discounted_cash": 2298.00, "minimum": 861.53, "maximum": 2525.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2525.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2525.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 861.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Relieve inner eye pressure", "code_information": [ { "code": "65820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18520.50, "discounted_cash": 11112.30, "minimum": 3578.37, "maximum": 10491.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 10491.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 10491.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3578.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Goniotomy lt", "code_information": [ { "code": "65820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18520.50, "discounted_cash": 11112.30, "minimum": 3578.37, "maximum": 10491.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 10491.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 10491.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3578.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Goniotomy rt", "code_information": [ { "code": "65820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18520.50, "discounted_cash": 11112.30, "minimum": 3578.37, "maximum": 10491.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 10491.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 10491.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3578.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl cplx wo ecp", "code_information": [ { "code": "66982", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12633.53, "discounted_cash": 7580.12, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl cplx wo ecp", "code_information": [ { "code": "66982", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12091.15, "discounted_cash": 7254.69, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl cplx wo ecp", "code_information": [ { "code": "66982", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12633.53, "discounted_cash": 7580.12, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1008.28, "10th_percentile": 1008.28, "90th_percentile": 1008.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "1 through 10", "median_amount": 2714.06, "10th_percentile": 2714.06, "90th_percentile": 2714.06, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2910.96, "10th_percentile": 2910.96, "90th_percentile": 2910.96, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl w/o ecp", "code_information": [ { "code": "66984", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12394.83, "discounted_cash": 7436.90, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl w/o ecp", "code_information": [ { "code": "66984", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12394.83, "discounted_cash": 7436.90, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2850.67, "10th_percentile": 2850.67, "90th_percentile": 2850.67, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "1 through 10", "median_amount": 7462.37, "10th_percentile": 6780.90, "90th_percentile": 8143.84, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 2985.05, "10th_percentile": 2774.03, "90th_percentile": 3128.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3098.44, "10th_percentile": 3098.44, "90th_percentile": 3098.44, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1008.28, "10th_percentile": 948.71, "90th_percentile": 1058.70, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "1 through 10", "median_amount": 2570.51, "10th_percentile": 2570.51, "90th_percentile": 2685.35, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2544.51, "10th_percentile": 2544.51, "90th_percentile": 2544.51, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1790.18, "10th_percentile": 1660.51, "90th_percentile": 1810.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2544.09, "10th_percentile": 2544.09, "90th_percentile": 2544.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl w/o ecp", "code_information": [ { "code": "66984", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12292.53, "discounted_cash": 7375.52, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2861.01, "10th_percentile": 2852.74, "90th_percentile": 3007.81, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "1 through 10", "median_amount": 7133.23, "10th_percentile": 7133.23, "90th_percentile": 7133.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 2924.10, "10th_percentile": 2678.07, "90th_percentile": 3179.37, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2843.48, "10th_percentile": 2715.10, "90th_percentile": 3039.66, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1008.28, "10th_percentile": 962.46, "90th_percentile": 1013.32, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "1 through 10", "median_amount": 2570.51, "10th_percentile": 2570.51, "90th_percentile": 2828.15, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2719.51, "10th_percentile": 2719.51, "90th_percentile": 2719.51, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1939.36, "10th_percentile": 1747.55, "90th_percentile": 2416.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2588.76, "10th_percentile": 2553.02, "90th_percentile": 2624.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exchange lens prosthesis", "code_information": [ { "code": "66986", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9821.00, "discounted_cash": 5892.60, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exchange of intraocular lens", "code_information": [ { "code": "66986", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9821.00, "discounted_cash": 5892.60, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Capsl ctrc rmvl insj 1+", "code_information": [ { "code": "66991", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14761.75, "discounted_cash": 8857.05, "minimum": 4589.61, "maximum": 13456.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 13456.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 13456.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4589.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl cataract w aqueous drai", "code_information": [ { "code": "66991", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14761.75, "discounted_cash": 8857.05, "minimum": 4589.61, "maximum": 13456.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 13456.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 13456.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4589.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial removal of eye fluid", "code_information": [ { "code": "67005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9821.00, "discounted_cash": 5892.60, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove vitreous ant appr part", "code_information": [ { "code": "67005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9821.00, "discounted_cash": 5892.60, "minimum": 2028.73, "maximum": 5948.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5948.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2028.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair eyelid defect", "code_information": [ { "code": "67917", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10824.50, "discounted_cash": 6494.70, "minimum": 2075.19, "maximum": 6084.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 6084.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 6084.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2075.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1093.68, "10th_percentile": 802.03, "90th_percentile": 1385.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain external ear lesion", "code_information": [ { "code": "69005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5406.50, "discounted_cash": 3243.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage ext ear lesion comp", "code_information": [ { "code": "69005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5406.50, "discounted_cash": 3243.90, "minimum": 1441.22, "maximum": 4225.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4225.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1441.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clear outer ear canal", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal fb ext auditory canal", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove impacted ear wax uni", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.52, "10th_percentile": 49.52, "90th_percentile": 49.52, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Uni removal impacted ear wax", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.52, "10th_percentile": 49.52, "90th_percentile": 49.52, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bil remove impacted ear wax", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 250.50, "discounted_cash": 150.30, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove impacted ear wax uni", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Uni remove imp ear wax w instr", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Temple bone implant revision", "code_information": [ { "code": "69717", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10824.50, "discounted_cash": 6494.70, "minimum": 6354.41, "maximum": 18630.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18630.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6354.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray eye for foreign body", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr fb eye", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of jaw <4views", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr mandible partial <4 vws", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of jaw 4/> views", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr mandible 4 view", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 321.78, "10th_percentile": 321.78, "90th_percentile": 321.78, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 464.41, "10th_percentile": 464.41, "90th_percentile": 464.41, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.82, "10th_percentile": 56.82, "90th_percentile": 56.82, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of mastoids", "code_information": [ { "code": "70120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr mastoids <3 views per side", "code_information": [ { "code": "70120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of mastoids", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr mastoids 3> vw", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of facial bones", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx rad facial bones partial", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of facial bones", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr facial bones > 3vw", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.10, "10th_percentile": 54.10, "90th_percentile": 54.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of nasal bones", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 133.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr nose 3 vw", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 133.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of eye sockets", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 171.12, "10th_percentile": 171.12, "90th_percentile": 171.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 355.99, "10th_percentile": 258.74, "90th_percentile": 453.24, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 440.75, "10th_percentile": 440.75, "90th_percentile": 440.75, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr orbits 4v", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of sinuses", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sinus 1 vw", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of sinuses", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sinuses paranasal comp 3 vw", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of skull", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr skull < 4 views", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of skull", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 371.53, "10th_percentile": 371.53, "90th_percentile": 371.53, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr skull 4 views", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of jaw joints", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr t m joints bilateral", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnetic image jaw joint", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri temporomandibular joint", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of neck", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr neck soft tissue", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 287.58, "10th_percentile": 278.80, "90th_percentile": 335.46, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.46, "10th_percentile": 46.46, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head/brain w/o dye", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1013.83, "10th_percentile": 260.43, "90th_percentile": 1767.24, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.56, "10th_percentile": 195.56, "90th_percentile": 195.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 509.79, "10th_percentile": 505.66, "90th_percentile": 513.92, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head wo contrast", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1616.35, "10th_percentile": 1616.35, "90th_percentile": 1616.35, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1616.35, "10th_percentile": 1616.35, "90th_percentile": 1616.35, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 324.19, "10th_percentile": 294.54, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "40", "median_amount": 1586.10, "10th_percentile": 1163.10, "90th_percentile": 1678.96, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "47", "median_amount": 577.30, "10th_percentile": 210.29, "90th_percentile": 1899.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1134.34, "10th_percentile": 225.94, "90th_percentile": 1870.64, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "159", "median_amount": 195.56, "10th_percentile": 186.23, "90th_percentile": 215.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "29", "median_amount": 583.19, "10th_percentile": 423.19, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 577.30, "10th_percentile": 521.75, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "107", "median_amount": 606.24, "10th_percentile": 424.37, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1470.60, "10th_percentile": 1470.60, "90th_percentile": 1470.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1470.60, "10th_percentile": 1470.60, "90th_percentile": 1470.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 516.87, "10th_percentile": 327.54, "90th_percentile": 668.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1750.51, "10th_percentile": 1750.51, "90th_percentile": 1820.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1750.51, "10th_percentile": 1750.51, "90th_percentile": 1820.70, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct head/brain w/dye", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head w contrast", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head/brain w/o & w/dye", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head w wo contrast", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 450.90, "10th_percentile": 450.90, "90th_percentile": 450.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.77, "10th_percentile": 150.77, "90th_percentile": 150.77, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 956.84, "10th_percentile": 956.84, "90th_percentile": 956.84, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbit/ear/fossa w/o dye", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbitsellafossaear wo cm", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1279.05, "10th_percentile": 1010.76, "90th_percentile": 1598.98, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 606.24, "10th_percentile": 606.24, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 462.78, "10th_percentile": 462.78, "90th_percentile": 462.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbit/ear/fossa w/dye", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct iac orbits w cm", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbit/ear/fossa w/o&w/dye", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct iac orbits w wo cm", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/o dye", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillary facial wo cm", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1398.37, "10th_percentile": 1242.72, "90th_percentile": 1595.03, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 349.23, "10th_percentile": 208.36, "90th_percentile": 686.43, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 464.18, "10th_percentile": 464.18, "90th_percentile": 464.18, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.56, "10th_percentile": 195.56, "90th_percentile": 204.85, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 508.19, "10th_percentile": 372.81, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 618.61, "10th_percentile": 476.25, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 577.30, "10th_percentile": 363.75, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 529.83, "10th_percentile": 278.78, "90th_percentile": 560.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/dye", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w cm", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 1286.31, "10th_percentile": 636.49, "90th_percentile": 1936.12, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 994.57, "10th_percentile": 994.57, "90th_percentile": 994.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/o & w/dye", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct facial w wo contrast", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct soft tissue neck w/o dye", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck soft tissue wo cm", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 589.08, "10th_percentile": 589.08, "90th_percentile": 589.08, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1485.12, "10th_percentile": 1485.12, "90th_percentile": 1485.12, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 884.18, "10th_percentile": 884.18, "90th_percentile": 884.18, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 200.20, "10th_percentile": 184.15, "90th_percentile": 212.04, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 591.77, "10th_percentile": 512.69, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 529.83, "10th_percentile": 519.46, "90th_percentile": 540.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 346.39, "10th_percentile": 346.39, "90th_percentile": 346.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 346.39, "10th_percentile": 346.39, "90th_percentile": 346.39, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct soft tissue neck w/dye", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck soft tissue w cm", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1014.86, "10th_percentile": 1014.86, "90th_percentile": 1014.86, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 2725.83, "10th_percentile": 767.76, "90th_percentile": 2763.56, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 690.62, "10th_percentile": 690.62, "90th_percentile": 690.62, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 364.68, "10th_percentile": 364.68, "90th_percentile": 364.68, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 320.83, "10th_percentile": 308.60, "90th_percentile": 346.49, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 872.07, "10th_percentile": 651.81, "90th_percentile": 932.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 954.03, "10th_percentile": 869.23, "90th_percentile": 1038.84, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct sft tsue nck w/o & w/dye", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck soft tissue w & wo cm", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angiography head", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cta head", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2357.10, "10th_percentile": 2357.10, "90th_percentile": 2357.10, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2357.10, "10th_percentile": 2357.10, "90th_percentile": 2357.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 724.88, "10th_percentile": 531.58, "90th_percentile": 918.17, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 2301.50, "10th_percentile": 1332.87, "90th_percentile": 2628.04, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1014.64, "10th_percentile": 170.00, "90th_percentile": 2331.11, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 328.46, "10th_percentile": 309.30, "90th_percentile": 344.50, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 980.78, "10th_percentile": 961.63, "90th_percentile": 999.93, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1014.86, "10th_percentile": 1014.86, "90th_percentile": 1014.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 994.57, "10th_percentile": 771.49, "90th_percentile": 994.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 890.46, "10th_percentile": 860.76, "90th_percentile": 1046.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angiography neck", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cta neck carotid", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1178.55, "10th_percentile": 1178.55, "90th_percentile": 1178.55, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1178.55, "10th_percentile": 1178.55, "90th_percentile": 1178.55, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 483.25, "10th_percentile": 483.25, "90th_percentile": 483.25, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 2426.50, "10th_percentile": 1332.87, "90th_percentile": 2754.43, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 656.80, "10th_percentile": 472.13, "90th_percentile": 904.92, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 492.65, "10th_percentile": 492.65, "90th_percentile": 492.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 328.46, "10th_percentile": 309.30, "90th_percentile": 344.50, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 980.78, "10th_percentile": 961.63, "90th_percentile": 999.93, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 864.86, "10th_percentile": 779.16, "90th_percentile": 984.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 994.57, "10th_percentile": 956.65, "90th_percentile": 994.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 890.46, "10th_percentile": 860.76, "90th_percentile": 1046.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbit/face/neck w/o dye", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbitfaceneck w/o cm", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbit/face/neck w/dye", "code_information": [ { "code": "70542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbitfaceneck w/cm", "code_information": [ { "code": "70542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbt/fac/nck w/o &w/dye", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbitfaceneck w&w/o cm", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3026.20, "10th_percentile": 3026.20, "90th_percentile": 3026.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1410.91, "10th_percentile": 1410.91, "90th_percentile": 1410.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiography head w/o dye", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra head w/o contrast", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 915.71, "10th_percentile": 915.71, "90th_percentile": 915.71, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 2441.50, "10th_percentile": 2294.75, "90th_percentile": 2539.24, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1180.71, "10th_percentile": 1180.71, "90th_percentile": 1180.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1035.98, "10th_percentile": 1035.98, "90th_percentile": 1035.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1035.98, "10th_percentile": 1035.98, "90th_percentile": 1035.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiograph head w/o&w/dye", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra head w & w/o cm", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiography neck w/o dye", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra neck w/o cm", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 915.71, "10th_percentile": 915.71, "90th_percentile": 915.71, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiography neck w/dye", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra neck w/cm", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiograph neck w/o&w/dye", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra neck w & w/o cm", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1889.68, "10th_percentile": 1889.68, "90th_percentile": 1889.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain stem w/o dye", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain w/brain stem w/ cm", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 944.57, "10th_percentile": 944.57, "90th_percentile": 944.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 2594.09, "10th_percentile": 2110.84, "90th_percentile": 2893.46, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 806.13, "10th_percentile": 783.46, "90th_percentile": 1125.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 400.80, "10th_percentile": 391.02, "90th_percentile": 410.58, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 1168.91, "10th_percentile": 964.34, "90th_percentile": 1168.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1180.71, "10th_percentile": 1180.71, "90th_percentile": 1180.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 694.27, "10th_percentile": 694.27, "90th_percentile": 1157.10, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 715.70, "10th_percentile": 715.70, "90th_percentile": 715.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 715.70, "10th_percentile": 715.70, "90th_percentile": 715.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 955.98, "10th_percentile": 955.98, "90th_percentile": 955.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain stem w/dye", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain w/brain stem w/ cm", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain stem w/o & w/dye", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain w/stem w/o & w/ cm", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1549.63, "10th_percentile": 1549.63, "90th_percentile": 1549.63, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1549.63, "10th_percentile": 1549.63, "90th_percentile": 1549.63, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1644.68, "10th_percentile": 921.29, "90th_percentile": 1759.15, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "1 through 10", "median_amount": 4582.52, "10th_percentile": 2480.82, "90th_percentile": 5078.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 1425.59, "10th_percentile": 1336.10, "90th_percentile": 1533.39, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 625.81, "10th_percentile": 588.85, "90th_percentile": 657.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "1 through 10", "median_amount": 1720.79, "10th_percentile": 1680.79, "90th_percentile": 1769.46, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1481.51, "10th_percentile": 1481.51, "90th_percentile": 1481.51, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1410.91, "10th_percentile": 1269.82, "90th_percentile": 1552.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1578.05, "10th_percentile": 1578.05, "90th_percentile": 1578.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1578.05, "10th_percentile": 1578.05, "90th_percentile": 1578.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1579.03, "10th_percentile": 1578.25, "90th_percentile": 1702.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam chest 1 view", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.68, "10th_percentile": 101.74, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 217.54, "10th_percentile": 53.67, "90th_percentile": 381.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 315.50, "10th_percentile": 246.28, "90th_percentile": 384.73, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 43.04, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 125.91, "90th_percentile": 132.28, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 124.64, "90th_percentile": 196.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr chest 1 vw", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 378.56, "10th_percentile": 371.10, "90th_percentile": 386.03, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 378.56, "10th_percentile": 371.10, "90th_percentile": 386.03, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 127.18, "10th_percentile": 119.06, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "107", "median_amount": 340.21, "10th_percentile": 253.85, "90th_percentile": 363.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 402.04, "10th_percentile": 282.33, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 152.46, "10th_percentile": 37.10, "90th_percentile": 368.40, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "248", "median_amount": 42.24, "10th_percentile": 40.21, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "44", "median_amount": 125.91, "10th_percentile": 125.91, "90th_percentile": 132.28, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 124.64, "10th_percentile": 99.07, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "183", "median_amount": 130.94, "10th_percentile": 124.64, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 333.36, "10th_percentile": 173.40, "90th_percentile": 369.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 333.36, "10th_percentile": 173.40, "90th_percentile": 369.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "48", "median_amount": 117.23, "10th_percentile": 102.06, "90th_percentile": 146.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 305.21, "90th_percentile": 397.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 305.21, "90th_percentile": 397.04, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray exam chest 2 views", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.53, "10th_percentile": 53.53, "90th_percentile": 53.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr chest 2 vw", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 359.17, "10th_percentile": 351.12, "90th_percentile": 367.22, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 359.17, "10th_percentile": 351.12, "90th_percentile": 367.22, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 107.18, "10th_percentile": 98.61, "90th_percentile": 125.79, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "79", "median_amount": 293.39, "10th_percentile": 181.13, "90th_percentile": 354.89, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "1 through 10", "median_amount": 137.33, "10th_percentile": 137.33, "90th_percentile": 137.33, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.61, "10th_percentile": 123.61, "90th_percentile": 123.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "83", "median_amount": 90.63, "10th_percentile": 3.54, "90th_percentile": 294.45, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.39, "10th_percentile": 19.86, "90th_percentile": 259.62, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 44.23, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "34", "median_amount": 117.27, "10th_percentile": 110.91, "90th_percentile": 132.28, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 83.61, "10th_percentile": 79.42, "90th_percentile": 105.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 87.25, "10th_percentile": 78.57, "90th_percentile": 124.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 194.01, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 194.01, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 117.23, "10th_percentile": 107.09, "90th_percentile": 143.01, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 231.68, "10th_percentile": 80.63, "90th_percentile": 391.30, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 231.68, "10th_percentile": 80.63, "90th_percentile": 391.30, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray exam chest 3 views", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr chest 3 vw", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam chest 4+ views", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr chest 4+ vw", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 136.93, "10th_percentile": 136.93, "90th_percentile": 136.93, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam ribs uni 2 views", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs left 2 vw", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.46, "10th_percentile": 43.08, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 110.91, "90th_percentile": 110.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.67, "10th_percentile": 78.05, "90th_percentile": 97.30, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.74, "10th_percentile": 91.74, "90th_percentile": 91.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.26, "10th_percentile": 111.26, "90th_percentile": 111.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs right 2vw", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.71, "10th_percentile": 3.54, "90th_percentile": 139.15, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.46, "10th_percentile": 46.46, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 102.91, "90th_percentile": 122.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.31, "10th_percentile": 72.61, "90th_percentile": 84.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs right 2vw", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam unilat ribs/chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs left 2vw w pa chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs right w pa chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.22, "10th_percentile": 75.22, "90th_percentile": 159.22, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 447.78, "10th_percentile": 447.78, "90th_percentile": 447.78, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.70, "10th_percentile": 167.70, "90th_percentile": 167.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.82, "10th_percentile": 48.71, "90th_percentile": 59.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.90, "10th_percentile": 140.90, "90th_percentile": 140.90, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 142.54, "10th_percentile": 111.53, "90th_percentile": 171.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.70, "10th_percentile": 157.70, "90th_percentile": 157.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs right w pa chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 71.29, "10th_percentile": 71.29, "90th_percentile": 71.29, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 71.29, "10th_percentile": 71.29, "90th_percentile": 71.29, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.92, "10th_percentile": 92.14, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 277.64, "10th_percentile": 277.64, "90th_percentile": 277.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 241.59, "10th_percentile": 81.05, "90th_percentile": 489.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.51, "10th_percentile": 55.19, "90th_percentile": 59.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 137.53, "10th_percentile": 134.83, "90th_percentile": 140.23, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.13, "10th_percentile": 126.81, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 427.26, "10th_percentile": 427.26, "90th_percentile": 427.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 427.26, "10th_percentile": 427.26, "90th_percentile": 427.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam ribs bil 3 views", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.72, "10th_percentile": 129.72, "90th_percentile": 129.72, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.29, "10th_percentile": 123.29, "90th_percentile": 123.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs bilateral 3 vw", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam ribs/chest4/> vws", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs bil w/chest pa", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 460.66, "10th_percentile": 460.66, "90th_percentile": 460.66, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.83, "10th_percentile": 60.35, "90th_percentile": 153.31, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam breastbone 2/>vws", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sternum min 2 vw", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray strenoclavic jt 3/>vws", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sternoclavicular jts < 3 vw", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thorax w/o dye", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 383.19, "10th_percentile": 383.19, "90th_percentile": 383.19, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest wo contrast", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 364.08, "10th_percentile": 281.80, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "23", "median_amount": 1352.06, "10th_percentile": 822.31, "90th_percentile": 1662.93, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "92", "median_amount": 577.30, "10th_percentile": 258.80, "90th_percentile": 1089.32, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 442.09, "10th_percentile": 139.27, "90th_percentile": 710.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "100", "median_amount": 195.56, "10th_percentile": 195.02, "90th_percentile": 215.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "26", "median_amount": 583.19, "10th_percentile": 383.19, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 494.89, "10th_percentile": 461.83, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "65", "median_amount": 485.00, "10th_percentile": 346.39, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 516.87, "10th_percentile": 431.29, "90th_percentile": 1573.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 516.87, "10th_percentile": 431.29, "90th_percentile": 1573.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 462.78, "10th_percentile": 328.47, "90th_percentile": 646.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 870.60, "10th_percentile": 870.60, "90th_percentile": 870.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 870.60, "10th_percentile": 870.60, "90th_percentile": 870.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct thorax w/dye", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest w contrast", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 641.50, "10th_percentile": 482.54, "90th_percentile": 889.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "11", "median_amount": 2165.01, "10th_percentile": 706.84, "90th_percentile": 2754.43, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 1142.38, "10th_percentile": 400.66, "90th_percentile": 2800.47, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 336.09, "10th_percentile": 316.24, "90th_percentile": 352.91, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 880.78, "10th_percentile": 781.63, "90th_percentile": 979.92, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 906.01, "10th_percentile": 873.09, "90th_percentile": 938.94, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 947.17, "10th_percentile": 596.75, "90th_percentile": 994.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1001.77, "10th_percentile": 912.72, "90th_percentile": 1090.82, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2412.62, "10th_percentile": 2320.65, "90th_percentile": 2895.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2412.62, "10th_percentile": 2320.65, "90th_percentile": 2895.15, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct thorax w/o & w/dye", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest w wo cm", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thorax lung cancer scr c-", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 603.85, "10th_percentile": 589.08, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 1373.08, "10th_percentile": 1079.62, "90th_percentile": 1606.83, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 606.24, "10th_percentile": 577.30, "90th_percentile": 784.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 591.77, "10th_percentile": 580.19, "90th_percentile": 603.35, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 586.68, "10th_percentile": 577.30, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "14", "median_amount": 583.19, "10th_percentile": 583.19, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 606.24, "10th_percentile": 577.30, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 404.12, "10th_percentile": 363.75, "90th_percentile": 424.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ldct for lung ca screen", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 603.85, "10th_percentile": 589.08, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 1373.08, "10th_percentile": 1079.62, "90th_percentile": 1606.83, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 606.24, "10th_percentile": 577.30, "90th_percentile": 784.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 591.77, "10th_percentile": 580.19, "90th_percentile": 603.35, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 586.68, "10th_percentile": 577.30, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "14", "median_amount": 583.19, "10th_percentile": 583.19, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 606.24, "10th_percentile": 577.30, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 404.12, "10th_percentile": 363.75, "90th_percentile": 424.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ldct for lung ca screen", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1247.16, "10th_percentile": 1247.16, "90th_percentile": 1247.16, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1247.16, "10th_percentile": 1247.16, "90th_percentile": 1247.16, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1170.63, "10th_percentile": 1170.61, "90th_percentile": 1170.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1170.63, "10th_percentile": 1170.61, "90th_percentile": 1170.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 452.26, "10th_percentile": 300.25, "90th_percentile": 613.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1750.51, "10th_percentile": 1750.51, "90th_percentile": 1750.51, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1750.51, "10th_percentile": 1750.51, "90th_percentile": 1750.51, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct angiography chest", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cta chest w wo contrast", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 966.50, "10th_percentile": 507.43, "90th_percentile": 1014.86, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "24", "median_amount": 2371.44, "10th_percentile": 1845.93, "90th_percentile": 2737.27, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 172.85, "10th_percentile": 77.41, "90th_percentile": 1354.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 320.83, "10th_percentile": 315.05, "90th_percentile": 336.09, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 956.84, "10th_percentile": 864.71, "90th_percentile": 956.84, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 947.17, "10th_percentile": 757.74, "90th_percentile": 994.56, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 956.84, "10th_percentile": 947.17, "90th_percentile": 994.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2642.35, "10th_percentile": 2458.57, "90th_percentile": 2826.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2642.35, "10th_percentile": 2458.57, "90th_percentile": 2826.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 890.46, "10th_percentile": 683.46, "90th_percentile": 1097.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2779.26, "10th_percentile": 2779.26, "90th_percentile": 2779.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2779.26, "10th_percentile": 2779.26, "90th_percentile": 2779.26, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mri chest w/o dye", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest w/o contrast", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 355.48, "10th_percentile": 355.48, "90th_percentile": 355.48, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest w/o & w/dye", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest w/ & w/o cm", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of spine 1 view", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr thoracic spine 1 vw", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr c spine 1 vw", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 133.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam neck spine 2-3 vw", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr c spine ap & lat", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.74, "10th_percentile": 101.74, "90th_percentile": 122.09, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 362.64, "10th_percentile": 356.44, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 83.88, "10th_percentile": 3.54, "90th_percentile": 294.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.75, "10th_percentile": 104.75, "90th_percentile": 104.75, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 41.02, "90th_percentile": 45.57, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 102.91, "90th_percentile": 122.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.17, "10th_percentile": 102.20, "90th_percentile": 122.15, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 91.74, "10th_percentile": 67.87, "90th_percentile": 129.68, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 114.41, "90th_percentile": 139.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray exam neck spine 4/5vws", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr c spine w/obl", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.72, "10th_percentile": 74.84, "90th_percentile": 140.97, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 422.64, "10th_percentile": 295.76, "90th_percentile": 472.29, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 259.44, "10th_percentile": 104.06, "90th_percentile": 471.92, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.51, "10th_percentile": 55.18, "90th_percentile": 61.89, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 154.41, "10th_percentile": 153.23, "90th_percentile": 161.23, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.90, "10th_percentile": 138.92, "90th_percentile": 172.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.70, "10th_percentile": 114.71, "90th_percentile": 157.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam neck spine 6/>vws", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr c spine w/obl flex & ext", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam thorac spine 2vws", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr thoracic spine 2 vw", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 144.72, "10th_percentile": 143.97, "90th_percentile": 172.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 390.22, "10th_percentile": 257.83, "90th_percentile": 424.37, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.19, "10th_percentile": 36.80, "90th_percentile": 286.16, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.10, "10th_percentile": 20.88, "90th_percentile": 56.00, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 156.94, "10th_percentile": 138.72, "90th_percentile": 175.16, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.39, "10th_percentile": 105.68, "90th_percentile": 161.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 137.98, "10th_percentile": 137.98, "90th_percentile": 137.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam thorac spine 3vws", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 262.89, "10th_percentile": 262.89, "90th_percentile": 262.89, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.08, "10th_percentile": 60.00, "90th_percentile": 150.16, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 152.93, "10th_percentile": 152.93, "90th_percentile": 152.93, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 134.16, "10th_percentile": 134.16, "90th_percentile": 134.16, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.53, "10th_percentile": 106.85, "90th_percentile": 116.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.14, "10th_percentile": 150.14, "90th_percentile": 150.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine/swimmers 3 vw", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam thoracolmb 2/> vw", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr thoracolumbar 2> vws", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.43, "10th_percentile": 100.77, "90th_percentile": 118.09, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 307.45, "10th_percentile": 307.45, "90th_percentile": 307.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 249.27, "10th_percentile": 249.27, "90th_percentile": 249.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.75, "10th_percentile": 104.75, "90th_percentile": 104.75, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.34, "10th_percentile": 44.45, "90th_percentile": 46.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 110.91, "90th_percentile": 110.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam entire spi 1 vw", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr scoliosis spine study", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 323.21, "10th_percentile": 296.74, "90th_percentile": 349.67, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam entire spi 2/3 vw", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr entire spi 2/3 vw", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 159.72, "10th_percentile": 159.72, "90th_percentile": 159.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.13, "10th_percentile": 176.13, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 154.41, "10th_percentile": 154.41, "90th_percentile": 154.41, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam l-s spine 2/3 vws", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine lumbar 2/3 vw", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 144.95, "10th_percentile": 130.82, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "28", "median_amount": 399.37, "10th_percentile": 281.34, "90th_percentile": 488.75, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 170.53, "10th_percentile": 40.30, "90th_percentile": 378.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 151.81, "10th_percentile": 62.60, "90th_percentile": 241.02, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 59.51, "10th_percentile": 54.76, "90th_percentile": 62.49, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 157.27, "10th_percentile": 154.41, "90th_percentile": 171.97, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.72, "10th_percentile": 120.90, "90th_percentile": 138.66, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 125.21, "10th_percentile": 105.68, "90th_percentile": 168.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 333.11, "10th_percentile": 192.78, "90th_percentile": 473.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 333.11, "10th_percentile": 192.78, "90th_percentile": 473.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.70, "10th_percentile": 151.65, "90th_percentile": 157.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam l-2 spine 4/>vws", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr lumbar spine w/obl", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 136.12, "10th_percentile": 136.12, "90th_percentile": 136.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 386.13, "10th_percentile": 345.26, "90th_percentile": 487.78, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 177.89, "10th_percentile": 40.30, "90th_percentile": 354.68, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.51, "10th_percentile": 44.61, "90th_percentile": 60.11, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 169.41, "10th_percentile": 164.23, "90th_percentile": 169.41, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.90, "10th_percentile": 125.69, "90th_percentile": 156.98, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 128.50, "10th_percentile": 117.39, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.14, "10th_percentile": 134.02, "90th_percentile": 157.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam l-s spine bending", "code_information": [ { "code": "72114", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ls spine compl w/bend vw", "code_information": [ { "code": "72114", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.51, "10th_percentile": 59.51, "90th_percentile": 59.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray bend only l-s spine", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of lower spine", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck spine w/o dye", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct spine cervical wo contrast", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 309.31, "10th_percentile": 294.54, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1553.96, "10th_percentile": 793.26, "90th_percentile": 1646.90, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 277.94, "10th_percentile": 207.75, "90th_percentile": 1862.24, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "59", "median_amount": 195.56, "10th_percentile": 186.11, "90th_percentile": 206.90, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "13", "median_amount": 583.19, "10th_percentile": 583.19, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 583.19, "10th_percentile": 577.30, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 606.24, "10th_percentile": 577.30, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 516.87, "10th_percentile": 404.09, "90th_percentile": 532.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck spine w/dye", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct c spine w cm", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck spine w/o & w/dye", "code_information": [ { "code": "72127", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct c spine w wo cm", "code_information": [ { "code": "72127", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest spine w/o dye", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thoracic spine limited", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "52", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thoracic spine limited", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 301.93, "10th_percentile": 296.02, "90th_percentile": 307.83, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1661.45, "10th_percentile": 1647.43, "90th_percentile": 1675.46, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 632.27, "10th_percentile": 333.12, "90th_percentile": 1015.44, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 200.20, "10th_percentile": 195.56, "90th_percentile": 215.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 612.42, "10th_percentile": 416.96, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 589.08, "10th_percentile": 460.75, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 474.93, "10th_percentile": 474.93, "90th_percentile": 474.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest spine w/dye", "code_information": [ { "code": "72129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thoracic spine w cm", "code_information": [ { "code": "72129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest spine w/o & w/dye", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thoracic spine w wo cm", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lumbar spine w/o dye", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lumbar spine wo contrast", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 309.31, "10th_percentile": 301.93, "90th_percentile": 463.96, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1425.91, "10th_percentile": 399.72, "90th_percentile": 1548.79, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1424.74, "10th_percentile": 1000.06, "90th_percentile": 1849.42, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 195.56, "10th_percentile": 189.03, "90th_percentile": 215.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 612.42, "10th_percentile": 383.19, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 577.30, "10th_percentile": 577.30, "90th_percentile": 577.30, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 606.24, "10th_percentile": 363.75, "90th_percentile": 606.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lumbar spine w/dye", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lumbar spine w cm", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 661.38, "10th_percentile": 661.38, "90th_percentile": 661.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lumbar spine w/o & w/dye", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lumbar spine w wo cm", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 568.31, "10th_percentile": 568.31, "90th_percentile": 568.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri neck spine w/o dye", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri cervical spine wo contrast", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 855.71, "10th_percentile": 463.43, "90th_percentile": 915.71, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "13", "median_amount": 2563.67, "10th_percentile": 2319.43, "90th_percentile": 3174.04, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 1129.53, "10th_percentile": 792.64, "90th_percentile": 2210.22, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 391.02, "10th_percentile": 288.45, "90th_percentile": 391.02, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 993.91, "10th_percentile": 968.91, "90th_percentile": 1084.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1030.71, "10th_percentile": 1030.71, "90th_percentile": 1030.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 771.37, "10th_percentile": 694.27, "90th_percentile": 890.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 955.98, "10th_percentile": 708.85, "90th_percentile": 955.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mri neck spine w/dye", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri cervical spine w/ cm", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest spine w/o dye", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri thoracic spine wo contrast", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 899.56, "10th_percentile": 864.48, "90th_percentile": 1124.48, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 2530.24, "10th_percentile": 2385.51, "90th_percentile": 2911.44, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 828.80, "10th_percentile": 819.73, "90th_percentile": 2059.39, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 391.02, "10th_percentile": 369.70, "90th_percentile": 402.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 1041.06, "10th_percentile": 938.77, "90th_percentile": 1143.34, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 881.57, "10th_percentile": 881.57, "90th_percentile": 881.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 771.37, "10th_percentile": 627.71, "90th_percentile": 1124.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 911.56, "10th_percentile": 851.50, "90th_percentile": 971.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mri chest spine w/dye", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri thoracic spine w/cm", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w/o dye", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w/o cm", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 915.71, "10th_percentile": 871.45, "90th_percentile": 955.71, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "20", "median_amount": 2723.89, "10th_percentile": 2068.21, "90th_percentile": 3144.66, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 828.80, "10th_percentile": 783.46, "90th_percentile": 1157.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 391.02, "10th_percentile": 355.48, "90th_percentile": 410.58, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 913.20, "10th_percentile": 873.20, "90th_percentile": 917.77, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 881.57, "10th_percentile": 881.57, "90th_percentile": 1149.21, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 771.37, "10th_percentile": 694.27, "90th_percentile": 1101.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1438.16, "10th_percentile": 504.19, "90th_percentile": 2372.14, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1438.16, "10th_percentile": 504.19, "90th_percentile": 2372.14, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 906.49, "10th_percentile": 404.25, "90th_percentile": 1067.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w/dye", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w/ cm", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri neck spine w/o & w/dye", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri cervical spine w & w/o cm", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1889.68, "10th_percentile": 1889.68, "90th_percentile": 1889.68, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1425.59, "10th_percentile": 1425.59, "90th_percentile": 1425.59, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 470.66, "10th_percentile": 470.66, "90th_percentile": 470.66, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1481.52, "10th_percentile": 1185.22, "90th_percentile": 1777.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest spine w/o & w/dye", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri thoracic spine w & w/o cm", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "1 through 10", "median_amount": 5361.15, "10th_percentile": 5361.15, "90th_percentile": 5361.15, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1381.65, "10th_percentile": 1381.65, "90th_percentile": 1381.65, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w/o & w/dye", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w & wo cm", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4937.56, "10th_percentile": 4937.56, "90th_percentile": 4937.56, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4937.56, "10th_percentile": 4937.56, "90th_percentile": 4937.56, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1799.63, "10th_percentile": 1799.63, "90th_percentile": 1799.63, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "1 through 10", "median_amount": 4017.80, "10th_percentile": 4017.80, "90th_percentile": 4017.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1489.27, "10th_percentile": 1453.97, "90th_percentile": 1524.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 597.37, "10th_percentile": 574.61, "90th_percentile": 620.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "1 through 10", "median_amount": 1720.79, "10th_percentile": 1649.46, "90th_percentile": 1769.46, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1842.09, "10th_percentile": 1842.09, "90th_percentile": 1842.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 942.44, "10th_percentile": 591.06, "90th_percentile": 1293.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of pelvis", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr pelvis 1/2 vw", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.72, "10th_percentile": 179.72, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 472.71, "10th_percentile": 460.65, "90th_percentile": 484.77, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 177.90, "10th_percentile": 74.56, "90th_percentile": 281.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.82, "10th_percentile": 54.10, "90th_percentile": 59.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.70, "10th_percentile": 144.23, "90th_percentile": 173.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.14, "10th_percentile": 110.48, "90th_percentile": 156.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angiograph pelv w/o&w/dye", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cta pelvis w cm", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/o dye", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis wo contrast", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 309.31, "10th_percentile": 309.31, "90th_percentile": 309.31, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1421.59, "10th_percentile": 1228.22, "90th_percentile": 1561.55, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 282.84, "10th_percentile": 264.54, "90th_percentile": 510.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 204.85, "10th_percentile": 197.42, "90th_percentile": 213.07, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 612.42, "10th_percentile": 612.42, "90th_percentile": 612.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 461.83, "10th_percentile": 456.21, "90th_percentile": 487.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 577.30, "10th_percentile": 577.30, "90th_percentile": 600.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 516.87, "10th_percentile": 473.60, "90th_percentile": 566.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/dye", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w cm", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2946.38, "10th_percentile": 2946.38, "90th_percentile": 2946.38, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2946.38, "10th_percentile": 2946.38, "90th_percentile": 2946.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/o & w/dye", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w wo contrast", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/o dye", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/o cm", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 2390.67, "10th_percentile": 2390.67, "90th_percentile": 2390.67, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1157.10, "10th_percentile": 1112.99, "90th_percentile": 1994.56, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 410.58, "10th_percentile": 410.58, "90th_percentile": 410.58, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1137.50, "10th_percentile": 1137.50, "90th_percentile": 1137.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/dye", "code_information": [ { "code": "72196", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/ cm", "code_information": [ { "code": "72196", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/o & w/dye", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/ & w/o cm", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "1 through 10", "median_amount": 3572.11, "10th_percentile": 3215.57, "90th_percentile": 3928.66, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1533.39, "10th_percentile": 1533.39, "90th_percentile": 1533.39, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "1 through 10", "median_amount": 1720.79, "10th_percentile": 1720.79, "90th_percentile": 1720.79, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1234.55, "10th_percentile": 1234.55, "90th_percentile": 1234.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angio pelvis w/o & w/dye", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3896.25, "discounted_cash": 2337.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra pelvis w or w/o cm", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3896.25, "discounted_cash": 2337.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam si joints 3/> vws", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 487.78, "10th_percentile": 487.78, "90th_percentile": 487.78, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.49, "10th_percentile": 62.49, "90th_percentile": 62.49, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 132.10, "10th_percentile": 125.05, "90th_percentile": 139.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sacroiliac jt >3 vw", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam sacrum tailbone", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.72, "10th_percentile": 34.55, "90th_percentile": 116.89, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 323.82, "10th_percentile": 211.13, "90th_percentile": 323.82, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 132.71, "10th_percentile": 131.29, "90th_percentile": 134.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 44.23, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 127.18, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.41, "10th_percentile": 14.44, "90th_percentile": 112.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.25, "10th_percentile": 112.25, "90th_percentile": 112.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sacrum coccyx min 2 vw", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray of lower spine disk", "code_information": [ { "code": "72295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.75, "discounted_cash": 58.05, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Discography lumbar rad interp", "code_information": [ { "code": "72295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.75, "discounted_cash": 58.05, "minimum": 1737.01, "maximum": 5092.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5092.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1737.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of collar bone", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr clavicle compl left", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 362.64, "10th_percentile": 362.64, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 3.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.21, "10th_percentile": 40.21, "90th_percentile": 40.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 99.71, "90th_percentile": 99.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr clavicle compl right", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 261.10, "10th_percentile": 261.10, "90th_percentile": 261.10, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr clavicle compl right", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulder blade", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr scapula compl left", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr scapula compl right", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.13, "10th_percentile": 176.13, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr scapula compl right", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulder", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr shoulder 1 vw left", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr shoulder 1 vw right", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr shoulder 1 vw right", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulder", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.18, "10th_percentile": 127.18, "90th_percentile": 127.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 316.03, "10th_percentile": 215.75, "90th_percentile": 328.39, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 128.18, "10th_percentile": 13.51, "90th_percentile": 266.33, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 40.21, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.61, "10th_percentile": 88.61, "90th_percentile": 128.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.57, "10th_percentile": 70.96, "90th_percentile": 91.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.62, "90th_percentile": 317.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.62, "90th_percentile": 317.63, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr shoulder 2/> vw", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 310.32, "10th_percentile": 310.32, "90th_percentile": 310.32, "methodology": "percent of total billed charges", "modifiers": "LT" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 310.32, "10th_percentile": 310.32, "90th_percentile": 310.32, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 100.17, "10th_percentile": 77.67, "90th_percentile": 126.82, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "16", "median_amount": 345.16, "10th_percentile": 226.03, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 127.79, "10th_percentile": 3.54, "90th_percentile": 134.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 202.79, "10th_percentile": 43.39, "90th_percentile": 362.19, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 42.24, "10th_percentile": 40.21, "90th_percentile": 44.92, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 117.27, "10th_percentile": 108.73, "90th_percentile": 125.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 83.02, "90th_percentile": 100.21, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 106.44, "10th_percentile": 79.58, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 97.64, "10th_percentile": 97.64, "90th_percentile": 97.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 97.64, "10th_percentile": 97.64, "90th_percentile": 97.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 112.84, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 91.66, "10th_percentile": 91.66, "90th_percentile": 91.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 91.66, "10th_percentile": 91.66, "90th_percentile": 91.66, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr shoulder right 2/> vw", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 310.32, "10th_percentile": 310.32, "90th_percentile": 310.32, "methodology": "percent of total billed charges", "modifiers": "RT" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 310.32, "10th_percentile": 310.32, "90th_percentile": 310.32, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 109.68, "10th_percentile": 98.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "17", "median_amount": 310.64, "10th_percentile": 270.31, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 308.24, "10th_percentile": 308.24, "90th_percentile": 308.24, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 104.75, "10th_percentile": 3.54, "90th_percentile": 372.28, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 43.23, "10th_percentile": 40.21, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 109.45, "90th_percentile": 132.28, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 99.71, "90th_percentile": 99.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 99.71, "10th_percentile": 80.93, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.41, "10th_percentile": 71.59, "90th_percentile": 143.01, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr shoulder right 2/> vw", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulders", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr acromioclavicular jnts", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 362.64, "10th_percentile": 362.64, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of humerus", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr humerus left 2 vw", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.40, "10th_percentile": 127.82, "90th_percentile": 132.97, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 332.96, "10th_percentile": 332.96, "90th_percentile": 332.96, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.87, "10th_percentile": 27.21, "90th_percentile": 346.01, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 40.81, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 132.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 99.71, "90th_percentile": 99.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 89.74, "90th_percentile": 124.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr humerus right 2 vw", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 321.31, "10th_percentile": 312.52, "90th_percentile": 330.11, "methodology": "percent of total billed charges", "modifiers": "RT" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 321.31, "10th_percentile": 312.52, "90th_percentile": 330.11, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.18, "10th_percentile": 127.18, "90th_percentile": 127.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 365.01, "10th_percentile": 365.01, "90th_percentile": 365.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 398.14, "10th_percentile": 378.76, "90th_percentile": 417.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 43.04, "90th_percentile": 45.57, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 121.59, "10th_percentile": 113.05, "90th_percentile": 130.14, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.57, "10th_percentile": 78.57, "90th_percentile": 78.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr humerus right 2 vw", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of elbow", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow left 2 vw", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 133.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 214.73, "10th_percentile": 150.53, "90th_percentile": 278.93, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 40.82, "90th_percentile": 45.19, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 110.91, "90th_percentile": 110.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.54, "10th_percentile": 103.22, "90th_percentile": 127.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow right 2 vw", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 251.71, "10th_percentile": 131.44, "90th_percentile": 371.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.91, "10th_percentile": 43.66, "90th_percentile": 46.15, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.79, "10th_percentile": 125.27, "90th_percentile": 130.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow left 2 vw", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of elbow", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 44.23, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.58, "10th_percentile": 102.58, "90th_percentile": 102.58, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow left 3> vw", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.40, "10th_percentile": 127.82, "90th_percentile": 132.97, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 292.01, "10th_percentile": 290.50, "90th_percentile": 300.99, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 202.79, "10th_percentile": 43.39, "90th_percentile": 362.19, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 40.55, "90th_percentile": 43.43, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 66.59, "10th_percentile": 19.13, "90th_percentile": 114.05, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.79, "10th_percentile": 101.55, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 60.18, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow right 3> vw", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.18, "10th_percentile": 40.32, "90th_percentile": 132.32, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 292.01, "10th_percentile": 145.17, "90th_percentile": 336.36, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 422.38, "10th_percentile": 184.19, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 40.21, "90th_percentile": 44.45, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 132.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 94.54, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow right 3> vw", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of forearm", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.92, "10th_percentile": 42.88, "90th_percentile": 108.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.92, "10th_percentile": 42.88, "90th_percentile": 108.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr forearm left 2 vw", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.18, "10th_percentile": 127.18, "90th_percentile": 127.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 293.39, "10th_percentile": 290.69, "90th_percentile": 305.27, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 189.10, "10th_percentile": 143.18, "90th_percentile": 235.03, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 43.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 132.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 103.44, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.74, "10th_percentile": 105.28, "90th_percentile": 139.01, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr forearm right 2 vw", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.40, "10th_percentile": 127.82, "90th_percentile": 132.97, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 353.90, "10th_percentile": 257.67, "90th_percentile": 725.28, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 249.27, "10th_percentile": 50.48, "90th_percentile": 387.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 41.43, "90th_percentile": 43.04, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 99.71, "90th_percentile": 99.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 77.20, "10th_percentile": 77.20, "90th_percentile": 77.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 77.20, "10th_percentile": 77.20, "90th_percentile": 77.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.56, "10th_percentile": 106.98, "90th_percentile": 142.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr forearm right 2 vw", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of arm infant", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr infant lower ext right 2 vw", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr infant lower ext right 2 vw", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr infant lower ext right 2 vw", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of wrist", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr wrist left 2 vw", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 690.36, "10th_percentile": 690.36, "90th_percentile": 690.36, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.98, "10th_percentile": 196.98, "90th_percentile": 196.98, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 132.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 91.74, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr wrist 2 vw", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 133.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 345.16, "10th_percentile": 345.16, "90th_percentile": 359.14, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.94, "10th_percentile": 81.94, "90th_percentile": 81.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr wrist 2 vw", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of wrist", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 263.55, "10th_percentile": 263.55, "90th_percentile": 263.55, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.35, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.61, "10th_percentile": 88.61, "90th_percentile": 128.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 91.66, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.09, "10th_percentile": 102.58, "90th_percentile": 111.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr wrist left 3/> vw", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 126.11, "10th_percentile": 120.11, "90th_percentile": 132.11, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 310.26, "10th_percentile": 173.82, "90th_percentile": 363.11, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 134.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 45.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 43.45, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.70, "10th_percentile": 86.38, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 85.25, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.94, "10th_percentile": 81.94, "90th_percentile": 116.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.94, "10th_percentile": 81.94, "90th_percentile": 116.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr wrist right 3/> view", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.61, "10th_percentile": 83.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "15", "median_amount": 332.96, "10th_percentile": 290.12, "90th_percentile": 365.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 292.01, "10th_percentile": 292.01, "90th_percentile": 292.01, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.69, "10th_percentile": 3.54, "90th_percentile": 126.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 422.38, "10th_percentile": 422.38, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 42.24, "10th_percentile": 40.21, "90th_percentile": 45.34, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 118.41, "10th_percentile": 112.41, "90th_percentile": 124.41, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 78.57, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 111.59, "90th_percentile": 111.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 111.59, "90th_percentile": 111.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 48.72, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.04, "10th_percentile": 397.04, "90th_percentile": 397.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.04, "10th_percentile": 397.04, "90th_percentile": 397.04, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr wrist right 3/> view", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of hand", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 343.23, "10th_percentile": 343.23, "90th_percentile": 343.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.49, "10th_percentile": 62.49, "90th_percentile": 62.49, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 508.50, "10th_percentile": 508.50, "90th_percentile": 508.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 508.50, "10th_percentile": 508.50, "90th_percentile": 508.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hand left 2 vw", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 429.58, "10th_percentile": 401.72, "90th_percentile": 457.44, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 540.96, "10th_percentile": 540.96, "90th_percentile": 540.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.73, "10th_percentile": 48.73, "90th_percentile": 48.73, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.51, "10th_percentile": 42.30, "90th_percentile": 59.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.13, "10th_percentile": 124.06, "90th_percentile": 166.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 131.38, "10th_percentile": 131.38, "90th_percentile": 131.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hand right 2 vw", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.92, "10th_percentile": 75.36, "90th_percentile": 160.48, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 337.14, "10th_percentile": 235.33, "90th_percentile": 438.96, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 392.81, "10th_percentile": 392.81, "90th_percentile": 392.81, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 346.98, "10th_percentile": 191.80, "90th_percentile": 502.16, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.82, "10th_percentile": 56.82, "90th_percentile": 56.82, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 177.93, "10th_percentile": 177.93, "90th_percentile": 177.93, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.72, "10th_percentile": 179.72, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.70, "10th_percentile": 127.45, "90th_percentile": 186.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hand right 2 vw", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of hand", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 323.82, "10th_percentile": 289.57, "90th_percentile": 345.57, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 291.71, "10th_percentile": 225.94, "90th_percentile": 357.47, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.34, "10th_percentile": 3.51, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 118.41, "10th_percentile": 112.41, "90th_percentile": 124.41, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.61, "10th_percentile": 88.61, "90th_percentile": 128.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 91.66, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.39, "10th_percentile": 57.75, "90th_percentile": 111.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hand left 3 vw", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.61, "10th_percentile": 20.39, "90th_percentile": 117.03, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "14", "median_amount": 293.39, "10th_percentile": 253.91, "90th_percentile": 357.40, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.84, "10th_percentile": 54.15, "90th_percentile": 211.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 41.15, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 110.91, "90th_percentile": 110.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.44, "10th_percentile": 80.63, "90th_percentile": 89.85, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 168.28, "90th_percentile": 365.86, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 168.28, "90th_percentile": 365.86, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr hand right 3 vw", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.03, "10th_percentile": 44.09, "90th_percentile": 131.68, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 290.11, "10th_percentile": 239.67, "90th_percentile": 326.50, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 76.20, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 422.38, "10th_percentile": 422.38, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 42.24, "10th_percentile": 40.21, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 113.91, "90th_percentile": 131.00, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 83.61, "90th_percentile": 119.18, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.64, "10th_percentile": 89.17, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 112.72, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 387.48, "10th_percentile": 379.83, "90th_percentile": 395.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 387.48, "10th_percentile": 379.83, "90th_percentile": 395.13, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr hand right 3 vw", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of finger(s)", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr finger left 2 vw", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 132.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.34, "10th_percentile": 85.62, "90th_percentile": 87.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr finger right 2 vw", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 307.96, "10th_percentile": 285.21, "90th_percentile": 349.91, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.46, "10th_percentile": 46.46, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.59, "10th_percentile": 82.47, "90th_percentile": 86.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr finger right 2 vw", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper extremity w/o dye", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext lt wo cm", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1175.27, "10th_percentile": 1175.27, "90th_percentile": 1175.27, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 360.31, "10th_percentile": 279.10, "90th_percentile": 441.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.56, "10th_percentile": 195.56, "90th_percentile": 195.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 422.81, "10th_percentile": 414.50, "90th_percentile": 431.11, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 359.42, "10th_percentile": 359.42, "90th_percentile": 359.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext rt wo cm", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 403.61, "10th_percentile": 403.61, "90th_percentile": 403.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1343.17, "10th_percentile": 1291.87, "90th_percentile": 1611.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 577.30, "10th_percentile": 345.65, "90th_percentile": 1204.07, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 215.12, "10th_percentile": 215.12, "90th_percentile": 215.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 383.19, "10th_percentile": 383.19, "90th_percentile": 383.19, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 485.00, "10th_percentile": 388.00, "90th_percentile": 581.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext rt wo cm", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper extremity w/dye", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext lt w cm", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext rt w cm", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext rt w cm", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6748.75, "discounted_cash": 4049.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct uppr extremity w/o&w/dye", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext lt w wo cm", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 2772.70, "10th_percentile": 2772.70, "90th_percentile": 2772.70, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 596.75, "10th_percentile": 596.75, "90th_percentile": 596.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext rt w wo cm", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper ext rt w wo cm", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri upper extremity w/o dye", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri forearm lt wo cm", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1985.89, "10th_percentile": 1985.89, "90th_percentile": 1985.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri hand rt wo cm", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri forearm rt wo cm", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri upper extremity w/dye", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri hand lt w cm", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri humerus rt w cm", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri forearm rt w cm", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri uppr extremity w/o&w/dye", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri forearm lt w wo cm", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri hand rt w wo cm", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri forearm rt w wo cm", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint upr extrem w/o dye", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri shoulder lt wo cm", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 2549.75, "10th_percentile": 2234.76, "90th_percentile": 2765.30, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 970.28, "10th_percentile": 838.60, "90th_percentile": 1650.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 373.25, "10th_percentile": 359.03, "90th_percentile": 387.47, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 913.20, "10th_percentile": 913.20, "90th_percentile": 913.20, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 694.27, "10th_percentile": 694.27, "90th_percentile": 936.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 409.98, "10th_percentile": 126.70, "90th_percentile": 826.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri wrist rt wo cm", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 890.08, "10th_percentile": 857.58, "90th_percentile": 922.58, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 2517.80, "10th_percentile": 1888.45, "90th_percentile": 2847.49, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 828.80, "10th_percentile": 783.46, "90th_percentile": 1157.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 783.46, "10th_percentile": 783.46, "90th_percentile": 783.46, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 391.02, "10th_percentile": 362.59, "90th_percentile": 406.67, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 913.20, "10th_percentile": 913.20, "90th_percentile": 953.20, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1030.71, "10th_percentile": 1030.71, "90th_percentile": 1030.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 809.97, "10th_percentile": 809.97, "90th_percentile": 809.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 882.58, "10th_percentile": 882.58, "90th_percentile": 882.58, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3074.16, "10th_percentile": 2860.35, "90th_percentile": 3287.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3074.16, "10th_percentile": 2860.35, "90th_percentile": 3287.97, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mri elbow rt wo cm", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint upr extrem w/dye", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri elbow lt w cm", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri shoulder rt w cm", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri elbow rt w cm", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint upr extr w/o&w/dye", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri shoulder lt w wo cm", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri shoulder rt w wo cm", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri elbow rt w wo cm", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam hip uni 1 view", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray hip uni 1 vw left", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.76, "10th_percentile": 104.76, "90th_percentile": 104.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hip uni 1 vw right", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hip uni 1 vw right", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam hip uni 2-3 views", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 43.04, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray hip uni 2-3 vw left", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.40, "10th_percentile": 112.67, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 323.73, "10th_percentile": 268.21, "90th_percentile": 363.35, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 99.71, "10th_percentile": 3.54, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 44.23, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 113.45, "90th_percentile": 129.73, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 86.83, "90th_percentile": 103.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 102.23, "10th_percentile": 79.44, "90th_percentile": 130.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.93, "10th_percentile": 114.93, "90th_percentile": 114.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray hip uni 2-3 vw right", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.03, "10th_percentile": 103.28, "90th_percentile": 128.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "18", "median_amount": 284.07, "10th_percentile": 194.50, "90th_percentile": 343.26, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 174.09, "10th_percentile": 104.75, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 3.54, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 43.35, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 116.59, "10th_percentile": 104.05, "90th_percentile": 129.13, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 76.67, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 89.50, "10th_percentile": 72.16, "90th_percentile": 127.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.04, "10th_percentile": 397.04, "90th_percentile": 397.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.04, "10th_percentile": 397.04, "90th_percentile": 397.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 111.59, "90th_percentile": 111.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray hip uni 2-3 vw right", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam hips bi 2 views", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hips bilat 2 vw", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 165.42, "10th_percentile": 138.32, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "17", "median_amount": 392.81, "10th_percentile": 270.21, "90th_percentile": 460.52, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 162.08, "10th_percentile": 43.67, "90th_percentile": 409.98, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 58.16, "10th_percentile": 54.10, "90th_percentile": 62.49, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 169.41, "10th_percentile": 158.67, "90th_percentile": 173.67, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 118.70, "10th_percentile": 118.70, "90th_percentile": 118.70, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 140.91, "10th_percentile": 105.68, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.93, "10th_percentile": 63.95, "90th_percentile": 149.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 467.88, "10th_percentile": 435.38, "90th_percentile": 500.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 467.88, "10th_percentile": 435.38, "90th_percentile": 500.38, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray exam of femur 1", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 132.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr femur 1 vw left", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr femur 1 vw right", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr femur 1 vw right", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of femur 2/>", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.64, "10th_percentile": 124.64, "90th_percentile": 124.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr femur left 2 vw", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 365.01, "10th_percentile": 365.01, "90th_percentile": 365.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 422.38, "10th_percentile": 422.38, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.23, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 119.86, "90th_percentile": 125.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.32, "10th_percentile": 84.91, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr femur right 2 vw", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 133.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 345.16, "10th_percentile": 345.16, "90th_percentile": 345.16, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 214.46, "10th_percentile": 166.33, "90th_percentile": 262.60, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.23, "10th_percentile": 40.21, "90th_percentile": 45.19, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.13, "10th_percentile": 125.54, "90th_percentile": 132.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr femur right 2 vw", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of knee 1 or 2", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.18, "10th_percentile": 127.18, "90th_percentile": 127.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 265.21, "10th_percentile": 205.21, "90th_percentile": 325.21, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 249.27, "10th_percentile": 249.27, "90th_percentile": 249.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 422.38, "10th_percentile": 422.38, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.46, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.62, "90th_percentile": 317.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.62, "90th_percentile": 317.63, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr knee left 1/2 vw", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 387.90, "10th_percentile": 387.90, "90th_percentile": 387.90, "methodology": "percent of total billed charges", "modifiers": "LT" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 387.90, "10th_percentile": 387.90, "90th_percentile": 387.90, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.74, "10th_percentile": 87.05, "90th_percentile": 119.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "15", "median_amount": 323.82, "10th_percentile": 276.13, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 130.94, "10th_percentile": 3.54, "90th_percentile": 400.37, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 107.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 22.83, "90th_percentile": 126.83, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 124.64, "10th_percentile": 81.94, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 100.43, "90th_percentile": 116.10, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee right 1/2 vw", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.18, "10th_percentile": 51.18, "90th_percentile": 123.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 298.12, "10th_percentile": 273.59, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 102.23, "10th_percentile": 3.54, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 44.23, "10th_percentile": 42.04, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 108.36, "90th_percentile": 110.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 93.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 99.71, "10th_percentile": 78.57, "90th_percentile": 124.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 96.81, "90th_percentile": 143.01, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee right 1/2 vw", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of knee 3", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 379.05, "10th_percentile": 379.05, "90th_percentile": 379.05, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 83.70, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee left 3 vw", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.18, "10th_percentile": 112.18, "90th_percentile": 112.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 282.96, "10th_percentile": 277.50, "90th_percentile": 341.62, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.24, "10th_percentile": 16.28, "90th_percentile": 118.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 40.21, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 129.09, "10th_percentile": 126.55, "90th_percentile": 131.63, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.64, "10th_percentile": 124.64, "90th_percentile": 124.64, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 89.04, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 111.59, "90th_percentile": 111.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee right 3 vw", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.89, "10th_percentile": 106.89, "90th_percentile": 106.89, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 311.32, "10th_percentile": 159.28, "90th_percentile": 366.97, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.97, "10th_percentile": 24.43, "90th_percentile": 359.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 45.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 125.91, "90th_percentile": 125.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 96.64, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee right 3 vw", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam knee 4 or more", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.10, "10th_percentile": 4.70, "90th_percentile": 59.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 171.91, "10th_percentile": 167.70, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee left w obliques", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.92, "10th_percentile": 139.25, "90th_percentile": 177.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 484.28, "10th_percentile": 435.71, "90th_percentile": 504.22, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.43, "10th_percentile": 48.73, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.82, "10th_percentile": 16.68, "90th_percentile": 58.97, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.72, "10th_percentile": 179.72, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.13, "10th_percentile": 149.94, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.70, "10th_percentile": 157.70, "90th_percentile": 157.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee right with obliques", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 439.01, "10th_percentile": 384.62, "90th_percentile": 502.33, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.73, "10th_percentile": 43.67, "90th_percentile": 272.73, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.82, "10th_percentile": 56.82, "90th_percentile": 58.70, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 169.41, "10th_percentile": 169.41, "90th_percentile": 169.41, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 113.73, "10th_percentile": 95.20, "90th_percentile": 132.27, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.76, "10th_percentile": 123.26, "90th_percentile": 170.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.70, "10th_percentile": 81.70, "90th_percentile": 81.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 534.07, "10th_percentile": 534.07, "90th_percentile": 534.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 534.07, "10th_percentile": 534.07, "90th_percentile": 534.07, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr knee right with obliques", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of knees", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee bilateral stand", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 117.18, "10th_percentile": 102.77, "90th_percentile": 128.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "20", "median_amount": 308.25, "10th_percentile": 269.55, "90th_percentile": 356.33, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 108.19, "10th_percentile": 3.54, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.75, "10th_percentile": 3.54, "90th_percentile": 172.03, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 44.23, "10th_percentile": 40.62, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 109.91, "90th_percentile": 118.13, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.66, "10th_percentile": 59.90, "90th_percentile": 110.72, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 87.25, "10th_percentile": 78.57, "90th_percentile": 88.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.41, "10th_percentile": 101.10, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.63, "90th_percentile": 317.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.63, "90th_percentile": 317.63, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray exam of lower leg", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tib fib left 2 vw", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.31, "10th_percentile": 102.25, "90th_percentile": 106.38, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 342.13, "10th_percentile": 312.59, "90th_percentile": 371.67, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 288.82, "10th_percentile": 288.82, "90th_percentile": 288.82, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.51, "10th_percentile": 154.05, "90th_percentile": 258.81, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 43.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 125.91, "90th_percentile": 125.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.64, "10th_percentile": 81.27, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 100.48, "90th_percentile": 139.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tib fib left 2vw", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 128.47, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 290.12, "10th_percentile": 290.11, "90th_percentile": 318.15, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 422.38, "10th_percentile": 422.38, "90th_percentile": 422.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.89, "10th_percentile": 24.16, "90th_percentile": 44.59, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 117.27, "10th_percentile": 117.27, "90th_percentile": 117.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 133.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.64, "10th_percentile": 97.20, "90th_percentile": 129.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tib fib left 2vw", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of leg infant", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr infant lower ext left 2 vw", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr infant lower ext right 2 vw", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr infant lower ext right 2 vw", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of ankle", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 345.16, "10th_percentile": 345.16, "90th_percentile": 345.16, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 185.57, "10th_percentile": 114.31, "90th_percentile": 256.83, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 118.41, "10th_percentile": 112.41, "90th_percentile": 124.41, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ankle left 2 vw", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.18, "10th_percentile": 111.18, "90th_percentile": 132.32, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 323.82, "10th_percentile": 316.93, "90th_percentile": 348.68, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 123.68, "90th_percentile": 133.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.28, "10th_percentile": 132.28, "90th_percentile": 132.28, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.58, "10th_percentile": 102.58, "90th_percentile": 102.58, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ankle right 2 vw", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.89, "10th_percentile": 28.27, "90th_percentile": 123.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 302.85, "10th_percentile": 290.11, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.27, "10th_percentile": 132.27, "90th_percentile": 132.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.64, "10th_percentile": 75.64, "90th_percentile": 75.64, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.64, "10th_percentile": 124.64, "90th_percentile": 124.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ankle right 2 vw", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of ankle", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 261.88, "10th_percentile": 133.47, "90th_percentile": 390.28, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.66, "10th_percentile": 91.66, "90th_percentile": 91.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ankle left 3 vw", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.61, "10th_percentile": 95.61, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "20", "median_amount": 291.75, "10th_percentile": 256.56, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 134.48, "10th_percentile": 74.54, "90th_percentile": 326.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 42.24, "10th_percentile": 40.62, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 113.91, "90th_percentile": 131.01, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.75, "10th_percentile": 100.72, "90th_percentile": 104.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 124.64, "10th_percentile": 78.57, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 74.46, "10th_percentile": 74.46, "90th_percentile": 74.46, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 74.46, "10th_percentile": 74.46, "90th_percentile": 74.46, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.41, "10th_percentile": 100.11, "90th_percentile": 128.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.04, "10th_percentile": 397.04, "90th_percentile": 397.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.04, "10th_percentile": 397.04, "90th_percentile": 397.04, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr ankle right 3 vw", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.61, "10th_percentile": 110.49, "90th_percentile": 133.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "17", "median_amount": 307.96, "10th_percentile": 148.88, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 290.11, "10th_percentile": 290.11, "90th_percentile": 290.11, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.64, "10th_percentile": 64.09, "90th_percentile": 134.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 42.24, "10th_percentile": 33.30, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 89.45, "10th_percentile": 85.62, "90th_percentile": 130.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 361.92, "10th_percentile": 361.92, "90th_percentile": 361.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 361.92, "10th_percentile": 361.92, "90th_percentile": 361.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.41, "10th_percentile": 111.59, "90th_percentile": 132.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ankle right 3 vw", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of foot", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 345.16, "10th_percentile": 345.16, "90th_percentile": 345.16, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.35, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 125.91, "10th_percentile": 125.91, "90th_percentile": 125.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.61, "10th_percentile": 88.61, "90th_percentile": 128.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr foot left 2 vw", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.40, "10th_percentile": 114.97, "90th_percentile": 125.82, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 365.01, "10th_percentile": 365.01, "90th_percentile": 365.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 257.98, "10th_percentile": 257.98, "90th_percentile": 257.98, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.11, "10th_percentile": 13.11, "90th_percentile": 13.11, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 121.59, "10th_percentile": 113.05, "90th_percentile": 130.14, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.52, "10th_percentile": 77.27, "90th_percentile": 99.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr foot right 2 vw", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.18, "10th_percentile": 127.18, "90th_percentile": 132.32, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 331.57, "10th_percentile": 283.12, "90th_percentile": 358.76, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.34, "10th_percentile": 54.27, "90th_percentile": 122.42, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.21, "10th_percentile": 40.21, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.34, "10th_percentile": 70.81, "90th_percentile": 131.86, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr foot right 2 vw", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of foot", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.74, "10th_percentile": 101.74, "90th_percentile": 117.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "11", "median_amount": 276.13, "10th_percentile": 125.91, "90th_percentile": 332.96, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 134.48, "10th_percentile": 121.87, "90th_percentile": 249.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.87, "10th_percentile": 121.87, "90th_percentile": 121.87, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 42.24, "10th_percentile": 40.41, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 121.59, "10th_percentile": 112.82, "90th_percentile": 130.36, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.71, "10th_percentile": 99.71, "90th_percentile": 99.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.80, "10th_percentile": 81.94, "90th_percentile": 91.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 116.21, "10th_percentile": 116.21, "90th_percentile": 116.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 116.21, "10th_percentile": 116.21, "90th_percentile": 116.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 83.69, "90th_percentile": 111.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr foot left 3 vw", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 106.89, "10th_percentile": 99.24, "90th_percentile": 121.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "16", "median_amount": 320.44, "10th_percentile": 258.87, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 129.05, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 402.04, "10th_percentile": 402.04, "90th_percentile": 402.04, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 43.23, "10th_percentile": 40.21, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 110.91, "10th_percentile": 106.63, "90th_percentile": 126.55, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.18, "10th_percentile": 78.03, "90th_percentile": 104.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 108.15, "10th_percentile": 80.25, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.63, "90th_percentile": 317.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 317.63, "10th_percentile": 317.63, "90th_percentile": 317.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.91, "10th_percentile": 100.11, "90th_percentile": 131.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.03, "10th_percentile": 381.74, "90th_percentile": 397.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 397.03, "10th_percentile": 381.74, "90th_percentile": 397.04, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr foot right 3 vw", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.89, "10th_percentile": 17.18, "90th_percentile": 114.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "24", "median_amount": 323.32, "10th_percentile": 284.25, "90th_percentile": 362.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 51.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 42.24, "10th_percentile": 36.75, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 114.09, "10th_percentile": 110.91, "90th_percentile": 123.32, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.94, "10th_percentile": 81.94, "90th_percentile": 81.94, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 87.25, "10th_percentile": 82.64, "90th_percentile": 122.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 117.23, "10th_percentile": 58.65, "90th_percentile": 118.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.93, "10th_percentile": 377.93, "90th_percentile": 377.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.93, "10th_percentile": 377.93, "90th_percentile": 377.93, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xr foot right 3 vw", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of heel", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr calcutaneous left 2 vw", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr calcutaneous right 2 vw", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 290.12, "10th_percentile": 290.12, "90th_percentile": 290.12, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr calcutaneous right 2 vw", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of toe(s)", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.61, "10th_percentile": 88.61, "90th_percentile": 128.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr toes left min 2 vw", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.74, "10th_percentile": 101.74, "90th_percentile": 101.74, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 130.94, "90th_percentile": 130.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.23, "10th_percentile": 44.23, "90th_percentile": 44.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.11, "10th_percentile": 79.88, "90th_percentile": 90.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr toes right min 2 vw", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.18, "10th_percentile": 107.18, "90th_percentile": 107.18, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.54, "10th_percentile": 3.54, "90th_percentile": 172.39, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.24, "10th_percentile": 42.24, "90th_percentile": 42.24, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 132.28, "10th_percentile": 132.28, "90th_percentile": 132.28, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr toes right min 2 vw", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower extremity w/o dye", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext lt wo cm", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 456.11, "10th_percentile": 326.11, "90th_percentile": 586.11, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1598.81, "10th_percentile": 1598.81, "90th_percentile": 1598.81, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.56, "10th_percentile": 195.56, "90th_percentile": 195.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 583.19, "10th_percentile": 583.19, "90th_percentile": 583.19, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 583.19, "10th_percentile": 578.48, "90th_percentile": 587.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 382.78, "10th_percentile": 382.78, "90th_percentile": 382.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext rt wo cm", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 618.61, "10th_percentile": 618.61, "90th_percentile": 618.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1678.96, "10th_percentile": 1678.96, "90th_percentile": 1678.96, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 222.07, "10th_percentile": 131.45, "90th_percentile": 312.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 190.89, "10th_percentile": 187.16, "90th_percentile": 194.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 404.12, "10th_percentile": 404.12, "90th_percentile": 542.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 516.87, "10th_percentile": 516.87, "90th_percentile": 516.87, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext rt wo cm", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower extremity w/dye", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext lt w cm", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext rt w cm", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 320.83, "10th_percentile": 320.83, "90th_percentile": 320.83, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext rt w cm", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lwr extremity w/o&w/dye", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext lt w wo cm", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 1419.99, "10th_percentile": 1419.99, "90th_percentile": 1419.99, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext rt w wo cm", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 2356.80, "10th_percentile": 2356.80, "90th_percentile": 2356.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 820.95, "10th_percentile": 820.95, "90th_percentile": 820.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower ext rt w wo cm", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lower extremity w/o dye", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri femur lt wo cm", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1985.89, "10th_percentile": 1985.89, "90th_percentile": 1985.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 391.02, "10th_percentile": 391.02, "90th_percentile": 391.02, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 1068.91, "10th_percentile": 988.91, "90th_percentile": 1148.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 986.62, "10th_percentile": 530.11, "90th_percentile": 986.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri foot rt wo cm", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 1601.98, "10th_percentile": 952.97, "90th_percentile": 2250.99, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 925.68, "10th_percentile": 925.68, "90th_percentile": 925.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 955.98, "10th_percentile": 955.98, "90th_percentile": 955.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri femur rt wo cm", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lower extremity w/dye", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri femur lt w cm", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri foot rt w cm", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri fibula rt w cm", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lwr extremity w/o&w/dye", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri femur lt w wo cm", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1369.41, "10th_percentile": 1369.41, "90th_percentile": 1369.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "1 through 10", "median_amount": 1777.27, "10th_percentile": 1777.27, "90th_percentile": 1777.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1234.55, "10th_percentile": 1234.55, "90th_percentile": 1234.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri foot rt w wo cm", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1441.09, "10th_percentile": 1437.84, "90th_percentile": 1444.33, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1727.11, "10th_percentile": 1450.74, "90th_percentile": 2003.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri femur rt w wo cm", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri jnt of lwr extre w/o dye", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 3116.16, "10th_percentile": 2967.51, "90th_percentile": 4861.87, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri ankle lt wo cm", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 899.56, "10th_percentile": 899.56, "90th_percentile": 899.56, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "1 through 10", "median_amount": 2899.34, "10th_percentile": 2567.78, "90th_percentile": 5361.17, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 970.28, "10th_percentile": 700.50, "90th_percentile": 1157.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 373.26, "10th_percentile": 336.38, "90th_percentile": 403.12, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 1066.06, "10th_percentile": 983.77, "90th_percentile": 1148.34, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 956.14, "10th_percentile": 896.48, "90th_percentile": 1015.80, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 694.27, "10th_percentile": 694.27, "90th_percentile": 879.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 906.62, "10th_percentile": 466.21, "90th_percentile": 955.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3341.42, "10th_percentile": 3341.42, "90th_percentile": 3341.42, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mri hip rt wo cm", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 944.57, "10th_percentile": 944.57, "90th_percentile": 944.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "14", "median_amount": 2587.36, "10th_percentile": 2173.00, "90th_percentile": 2942.03, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 845.95, "10th_percentile": 783.46, "90th_percentile": 1910.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "1 through 10", "median_amount": 918.91, "10th_percentile": 918.91, "90th_percentile": 918.91, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1030.71, "10th_percentile": 946.69, "90th_percentile": 1030.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 694.27, "10th_percentile": 694.27, "90th_percentile": 694.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 955.98, "10th_percentile": 774.84, "90th_percentile": 971.30, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3508.62, "10th_percentile": 3508.62, "90th_percentile": 3508.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3508.62, "10th_percentile": 3508.62, "90th_percentile": 3508.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mri knee rt wo cm", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint of lwr extr w/dye", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri ankle lt w cm", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri hip rt w cm", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri ankle rt w cm", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11842.25, "discounted_cash": 7105.35, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint lwr extr w/o&w/dye", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri ankle lt w wo cm", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "1 through 10", "median_amount": 4103.06, "10th_percentile": 4103.06, "90th_percentile": 4103.06, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1739.68, "10th_percentile": 1739.68, "90th_percentile": 1739.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri hip rt w wo cm", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "1 through 10", "median_amount": 4398.03, "10th_percentile": 4398.03, "90th_percentile": 4398.03, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri knee rt w wo cm", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr ang lwr ext w or w/o dye", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3872.25, "discounted_cash": 2323.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra low ext w/cm;w/ocm/w&w/ocm", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3872.25, "discounted_cash": 2323.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam abdomen 1 view", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.21, "10th_percentile": 40.21, "90th_percentile": 40.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 117.23, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr abdomen 1 vw", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 369.23, "10th_percentile": 369.23, "90th_percentile": 369.23, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.74, "10th_percentile": 98.61, "90th_percentile": 119.95, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "14", "median_amount": 287.49, "10th_percentile": 121.77, "90th_percentile": 322.50, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.94, "10th_percentile": 129.68, "90th_percentile": 288.11, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 43.23, "10th_percentile": 42.24, "90th_percentile": 46.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 117.27, "10th_percentile": 117.27, "90th_percentile": 127.78, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.34, "10th_percentile": 96.91, "90th_percentile": 105.78, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 91.66, "10th_percentile": 78.57, "90th_percentile": 129.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 106.01, "90th_percentile": 117.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 377.92, "10th_percentile": 377.92, "90th_percentile": 377.92, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray exam abdomen 2 views", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr abdomen 2 vw", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 496.80, "10th_percentile": 496.80, "90th_percentile": 496.80, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 496.80, "10th_percentile": 496.80, "90th_percentile": 496.80, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 161.75, "10th_percentile": 140.03, "90th_percentile": 176.28, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "16", "median_amount": 399.08, "10th_percentile": 320.97, "90th_percentile": 489.39, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 438.98, "10th_percentile": 438.98, "90th_percentile": 438.98, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.73, "10th_percentile": 46.20, "90th_percentile": 293.74, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.84, "10th_percentile": 176.84, "90th_percentile": 176.84, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 59.51, "10th_percentile": 56.82, "90th_percentile": 62.49, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 169.41, "10th_percentile": 169.41, "90th_percentile": 176.23, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 135.26, "10th_percentile": 131.05, "90th_percentile": 359.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.82, "10th_percentile": 120.69, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 357.60, "10th_percentile": 229.22, "90th_percentile": 485.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 357.60, "10th_percentile": 229.22, "90th_percentile": 485.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.70, "10th_percentile": 145.28, "90th_percentile": 321.67, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 406.80, "10th_percentile": 406.80, "90th_percentile": 406.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 406.80, "10th_percentile": 406.80, "90th_percentile": 406.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray exam complete abdomen", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr abdomen acute series", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.12, "10th_percentile": 61.12, "90th_percentile": 61.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 464.41, "10th_percentile": 388.36, "90th_percentile": 488.10, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 398.73, "10th_percentile": 398.73, "90th_percentile": 398.73, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.51, "10th_percentile": 56.82, "90th_percentile": 59.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 173.67, "10th_percentile": 170.26, "90th_percentile": 177.08, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.13, "10th_percentile": 142.55, "90th_percentile": 426.63, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.70, "10th_percentile": 118.01, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.70, "10th_percentile": 157.70, "90th_percentile": 157.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/o dye", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen wo contrast", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1995.50, "discounted_cash": 1197.30, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 494.89, "10th_percentile": 494.89, "90th_percentile": 494.89, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "1 through 10", "median_amount": 1646.54, "10th_percentile": 1646.54, "90th_percentile": 1646.54, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 326.88, "10th_percentile": 152.41, "90th_percentile": 501.35, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.56, "10th_percentile": 195.56, "90th_percentile": 195.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "1 through 10", "median_amount": 583.19, "10th_percentile": 583.19, "90th_percentile": 583.19, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 424.37, "10th_percentile": 424.37, "90th_percentile": 424.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 462.78, "10th_percentile": 462.78, "90th_percentile": 462.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/dye", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen with contrast", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 302.70, "10th_percentile": 302.70, "90th_percentile": 302.70, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/o & w/dye", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w & wo contrast", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 723.22, "10th_percentile": 294.17, "90th_percentile": 1401.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 320.83, "10th_percentile": 320.83, "90th_percentile": 320.83, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 956.84, "10th_percentile": 956.84, "90th_percentile": 956.84, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 663.02, "10th_percentile": 663.02, "90th_percentile": 663.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abd&pelv w/o&w/dye", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4514.75, "discounted_cash": 2708.85, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cta abdomen pelvis w cm", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4514.75, "discounted_cash": 2708.85, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1399.57, "10th_percentile": 1399.57, "90th_percentile": 1399.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "1 through 10", "median_amount": 3264.39, "10th_percentile": 1747.53, "90th_percentile": 3706.00, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2770.27, "10th_percentile": 2770.27, "90th_percentile": 2770.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 442.45, "10th_percentile": 442.45, "90th_percentile": 442.45, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1352.91, "10th_percentile": 1315.59, "90th_percentile": 1390.24, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1371.58, "10th_percentile": 1306.27, "90th_percentile": 1371.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3620.18, "10th_percentile": 3620.18, "90th_percentile": 3620.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3620.18, "10th_percentile": 3620.18, "90th_percentile": 3620.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1535.02, "10th_percentile": 1535.02, "90th_percentile": 1535.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abdom w/o & w/dye", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 375.37, "10th_percentile": 362.29, "90th_percentile": 388.45, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 820.95, "10th_percentile": 820.95, "90th_percentile": 820.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 890.46, "10th_percentile": 890.46, "90th_percentile": 890.46, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cta abdomen w contrast", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 375.37, "10th_percentile": 362.29, "90th_percentile": 388.45, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 820.95, "10th_percentile": 820.95, "90th_percentile": 820.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 890.46, "10th_percentile": 890.46, "90th_percentile": 890.46, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abd & pelvis w/o contrast", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3936.00, "discounted_cash": 2361.60, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1542.91, "10th_percentile": 1542.91, "90th_percentile": 1542.91, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1138.80, "10th_percentile": 1138.80, "90th_percentile": 1138.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen pelvis wo contrast", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3936.00, "discounted_cash": 2361.60, "minimum": 199.74, "maximum": 585.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 1162.04, "10th_percentile": 897.04, "90th_percentile": 1220.16, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 585.62, "count": "40", "median_amount": 2680.81, "10th_percentile": 1289.58, "90th_percentile": 3249.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 585.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 867.46, "10th_percentile": 197.63, "90th_percentile": 1195.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 867.46, "10th_percentile": 763.47, "90th_percentile": 1089.73, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "129", "median_amount": 385.73, "10th_percentile": 373.28, "90th_percentile": 424.30, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 199.74, "count": "27", "median_amount": 1150.41, "10th_percentile": 1004.94, "90th_percentile": 1207.96, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 1138.80, "10th_percentile": 976.13, "90th_percentile": 1220.16, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 1195.76, "10th_percentile": 944.65, "90th_percentile": 1195.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2261.86, "10th_percentile": 1308.84, "90th_percentile": 3214.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2261.86, "10th_percentile": 1308.84, "90th_percentile": 3214.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 939.59, "10th_percentile": 441.50, "90th_percentile": 1070.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3199.46, "10th_percentile": 2125.40, "90th_percentile": 3625.84, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3199.46, "10th_percentile": 2125.40, "90th_percentile": 3625.84, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct abd & pelv w/contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4514.75, "discounted_cash": 2708.85, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 442.45, "10th_percentile": 442.45, "90th_percentile": 442.45, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen pelvis w contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4514.75, "discounted_cash": 2708.85, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1585.78, "10th_percentile": 1585.78, "90th_percentile": 1585.78, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1585.78, "10th_percentile": 1585.78, "90th_percentile": 1585.78, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 1399.57, "10th_percentile": 1332.92, "90th_percentile": 1399.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "55", "median_amount": 3489.88, "10th_percentile": 2111.04, "90th_percentile": 3798.62, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 335.61, "10th_percentile": 335.61, "90th_percentile": 335.61, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1306.27, "10th_percentile": 1306.27, "90th_percentile": 1306.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 710.38, "10th_percentile": 95.10, "90th_percentile": 1197.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 739.33, "10th_percentile": 739.33, "90th_percentile": 739.33, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 442.45, "10th_percentile": 421.38, "90th_percentile": 463.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 1319.59, "10th_percentile": 1219.59, "90th_percentile": 1385.58, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 1306.26, "10th_percentile": 1249.57, "90th_percentile": 1399.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "53", "median_amount": 1306.27, "10th_percentile": 992.76, "90th_percentile": 1371.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3960.93, "10th_percentile": 3123.08, "90th_percentile": 4099.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3960.93, "10th_percentile": 3123.08, "90th_percentile": 4099.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 1104.78, "10th_percentile": 857.65, "90th_percentile": 1535.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3711.32, "10th_percentile": 3277.26, "90th_percentile": 4069.46, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3711.32, "10th_percentile": 3277.26, "90th_percentile": 4069.46, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct abd & pelv 1/> regns", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4514.75, "discounted_cash": 2708.85, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen pelvis w & wo cm", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4514.75, "discounted_cash": 2708.85, "minimum": 387.04, "maximum": 1134.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1184.57, "10th_percentile": 1100.45, "90th_percentile": 1331.26, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1134.78, "count": "1 through 10", "median_amount": 2959.10, "10th_percentile": 2497.26, "90th_percentile": 3510.53, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1134.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 839.68, "10th_percentile": 822.44, "90th_percentile": 1917.74, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 822.44, "10th_percentile": 822.44, "90th_percentile": 822.44, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 452.98, "10th_percentile": 442.45, "90th_percentile": 479.74, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 387.04, "count": "1 through 10", "median_amount": 1277.59, "10th_percentile": 1144.59, "90th_percentile": 1385.58, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1306.26, "10th_percentile": 1306.26, "90th_percentile": 1306.26, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 937.25, "10th_percentile": 822.95, "90th_percentile": 1142.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1085.68, "10th_percentile": 566.07, "90th_percentile": 1344.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4158.99, "10th_percentile": 4158.99, "90th_percentile": 4158.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4158.99, "10th_percentile": 4158.99, "90th_percentile": 4158.99, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mri abdomen w/o dye", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/o cm", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3808.75, "discounted_cash": 2285.25, "minimum": 480.58, "maximum": 1409.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 915.71, "10th_percentile": 915.71, "90th_percentile": 915.71, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1409.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 373.26, "10th_percentile": 373.26, "90th_percentile": 373.26, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 480.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 955.98, "10th_percentile": 955.98, "90th_percentile": 955.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/o & w/dye", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w & wo cm", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1549.63, "10th_percentile": 1519.32, "90th_percentile": 1621.67, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "1 through 10", "median_amount": 4772.25, "10th_percentile": 4772.25, "90th_percentile": 4772.25, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1271.69, "10th_percentile": 745.88, "90th_percentile": 1457.62, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 597.39, "10th_percentile": 577.46, "90th_percentile": 617.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "1 through 10", "median_amount": 1781.64, "10th_percentile": 1732.96, "90th_percentile": 1852.96, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1111.14, "10th_percentile": 1111.14, "90th_percentile": 1111.14, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1538.54, "10th_percentile": 1506.93, "90th_percentile": 1570.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1058.19, "10th_percentile": 1058.19, "90th_percentile": 1058.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1058.19, "10th_percentile": 1058.19, "90th_percentile": 1058.19, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray bile ducts/pancreas", "code_information": [ { "code": "74300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "O r cholangiogram", "code_information": [ { "code": "74300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Contrst x-ray urinary tract", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 950.75, "discounted_cash": 570.45, "minimum": 158.35, "maximum": 464.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 158.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr iv pyelogram", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 950.75, "discounted_cash": 570.45, "minimum": 158.35, "maximum": 464.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 158.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Contrst x-ray urinary tract", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1959.75, "discounted_cash": 1175.85, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr retrograde pyolgram or", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1959.75, "discounted_cash": 1175.85, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct hrt w/o dye w/ca test", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct heart wo dye w ca", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct hrt w/3d image congen", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct heart w 3d image cong hrt", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 416.00, "discounted_cash": 249.60, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct heart w 3d image cong hrt", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio hrt w/3d image", "code_information": [ { "code": "75574", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2550.00, "discounted_cash": 1530.00, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct heart angio w 3d image", "code_information": [ { "code": "75574", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 812.50, "discounted_cash": 487.50, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct heart angio w 3d image", "code_information": [ { "code": "75574", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2550.00, "discounted_cash": 1530.00, "minimum": 317.67, "maximum": 931.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 931.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 317.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 464.82, "10th_percentile": 464.82, "90th_percentile": 464.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Quan&char c athrosclrtc plaq", "code_information": [ { "code": "75577", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2375.00, "discounted_cash": 1425.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Quan & char c athrosclrtc plaq", "code_information": [ { "code": "75577", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2375.00, "discounted_cash": 1425.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N-invas est c ffr sw aly cta", "code_information": [ { "code": "75580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3750.00, "discounted_cash": 2250.00, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N-invas est c ffrct sw aly cta", "code_information": [ { "code": "75580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3750.00, "discounted_cash": 2250.00, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 683.55, "10th_percentile": 683.55, "90th_percentile": 683.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abdominal arteries", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 158.35, "maximum": 464.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 158.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abdominal arteries", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3273.75, "discounted_cash": 1964.25, "minimum": 158.35, "maximum": 464.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1014.86, "10th_percentile": 1014.86, "90th_percentile": 1014.86, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 464.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 406.09, "10th_percentile": 297.48, "90th_percentile": 1143.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 679.89, "10th_percentile": 679.89, "90th_percentile": 679.89, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 320.83, "10th_percentile": 320.83, "90th_percentile": 333.04, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 158.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 947.17, "10th_percentile": 881.32, "90th_percentile": 947.17, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 696.20, "10th_percentile": 669.66, "90th_percentile": 696.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoroscopy <1 hr phys/qhp", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1224.75, "discounted_cash": 734.85, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoroscopy up to one hour", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1224.75, "discounted_cash": 734.85, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam surgical specimen", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2571.00, "discounted_cash": 1542.60, "minimum": 487.72, "maximum": 1429.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 487.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mammogram breast specimen", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2571.00, "discounted_cash": 1542.60, "minimum": 487.72, "maximum": 1429.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 487.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam of head and neck", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us neck soft tissue", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 730.02, "10th_percentile": 730.02, "90th_percentile": 730.02, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 730.02, "10th_percentile": 730.02, "90th_percentile": 730.02, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 257.73, "10th_percentile": 223.51, "90th_percentile": 268.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "21", "median_amount": 676.42, "10th_percentile": 536.12, "90th_percentile": 745.04, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 146.40, "10th_percentile": 48.40, "90th_percentile": 273.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.01, "10th_percentile": 33.88, "90th_percentile": 248.14, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.52, "10th_percentile": 87.59, "90th_percentile": 97.16, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 248.40, "10th_percentile": 229.68, "90th_percentile": 253.68, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 211.74, "10th_percentile": 208.59, "90th_percentile": 229.39, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 164.28, "10th_percentile": 152.34, "90th_percentile": 213.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.38, "10th_percentile": 205.29, "90th_percentile": 213.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.38, "10th_percentile": 205.29, "90th_percentile": 213.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 245.14, "10th_percentile": 214.50, "90th_percentile": 273.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 790.62, "10th_percentile": 275.41, "90th_percentile": 822.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 790.62, "10th_percentile": 275.41, "90th_percentile": 822.31, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us exam chest", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us tissue mass chest upper bck", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ultrasound breast complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us breast lt complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us breast rt complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 266.06, "10th_percentile": 266.06, "90th_percentile": 266.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us breast rt complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ultrasound breast limited", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1000.50, "discounted_cash": 600.30, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 551.72, "10th_percentile": 519.72, "90th_percentile": 703.10, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.56, "10th_percentile": 176.56, "90th_percentile": 176.56, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 195.73, "10th_percentile": 195.73, "90th_percentile": 195.73, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.38, "10th_percentile": 182.38, "90th_percentile": 182.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 119.23, "10th_percentile": 87.10, "90th_percentile": 151.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 119.23, "10th_percentile": 87.10, "90th_percentile": 151.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 227.72, "10th_percentile": 227.72, "90th_percentile": 227.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 460.83, "10th_percentile": 460.83, "90th_percentile": 460.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 460.83, "10th_percentile": 460.83, "90th_percentile": 460.83, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us breast limited bilateral", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1000.50, "discounted_cash": 600.30, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.38, "10th_percentile": 182.38, "90th_percentile": 182.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us breast limited lt", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 669.75, "discounted_cash": 401.85, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 207.62, "10th_percentile": 207.62, "90th_percentile": 207.62, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 502.79, "10th_percentile": 416.46, "90th_percentile": 567.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.52, "10th_percentile": 86.36, "90th_percentile": 168.68, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.75, "10th_percentile": 68.75, "90th_percentile": 68.75, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "1 through 10", "median_amount": 180.73, "10th_percentile": 180.73, "90th_percentile": 180.73, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 157.62, "10th_percentile": 157.62, "90th_percentile": 157.62, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 135.63, "10th_percentile": 122.08, "90th_percentile": 169.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.18, "10th_percentile": 182.18, "90th_percentile": 182.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 376.30, "10th_percentile": 183.76, "90th_percentile": 568.84, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 376.30, "10th_percentile": 183.76, "90th_percentile": 568.84, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us breast limited rt", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 669.75, "discounted_cash": 401.85, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 197.70, "10th_percentile": 197.70, "90th_percentile": 205.64, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "1 through 10", "median_amount": 478.43, "10th_percentile": 388.64, "90th_percentile": 564.22, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.07, "10th_percentile": 66.35, "90th_percentile": 174.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.20, "10th_percentile": 72.20, "90th_percentile": 72.20, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 122.08, "10th_percentile": 120.33, "90th_percentile": 157.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 227.72, "10th_percentile": 227.72, "90th_percentile": 227.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us breast limited bilateral", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1000.50, "discounted_cash": 600.30, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam abdom complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us abdomen complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 223.51, "10th_percentile": 223.51, "90th_percentile": 223.51, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "1 through 10", "median_amount": 682.07, "10th_percentile": 629.49, "90th_percentile": 746.65, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 203.57, "10th_percentile": 133.34, "90th_percentile": 607.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.22, "10th_percentile": 84.53, "90th_percentile": 87.91, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "1 through 10", "median_amount": 262.50, "10th_percentile": 251.22, "90th_percentile": 273.77, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 229.39, "10th_percentile": 212.75, "90th_percentile": 229.39, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 156.45, "10th_percentile": 106.59, "90th_percentile": 184.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 219.58, "10th_percentile": 219.58, "90th_percentile": 219.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 219.58, "10th_percentile": 219.58, "90th_percentile": 219.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.14, "10th_percentile": 236.96, "90th_percentile": 288.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echo exam of abdomen", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "1 through 10", "median_amount": 604.39, "10th_percentile": 583.01, "90th_percentile": 625.77, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 426.49, "10th_percentile": 202.42, "90th_percentile": 650.56, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.87, "10th_percentile": 104.14, "90th_percentile": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us abdomen ruq limited", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 259.39, "10th_percentile": 139.70, "90th_percentile": 279.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "21", "median_amount": 556.87, "10th_percentile": 366.63, "90th_percentile": 722.07, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 260.74, "10th_percentile": 260.74, "90th_percentile": 260.74, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 146.40, "10th_percentile": 133.34, "90th_percentile": 273.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.40, "10th_percentile": 135.95, "90th_percentile": 204.51, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 92.52, "10th_percentile": 85.65, "90th_percentile": 97.16, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "1 through 10", "median_amount": 251.59, "10th_percentile": 249.04, "90th_percentile": 259.59, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.68, "10th_percentile": 222.31, "90th_percentile": 273.05, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 260.74, "10th_percentile": 164.28, "90th_percentile": 273.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 236.41, "10th_percentile": 202.24, "90th_percentile": 277.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 810.23, "10th_percentile": 794.23, "90th_percentile": 826.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 810.23, "10th_percentile": 794.23, "90th_percentile": 826.23, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us abdl aorta screen aaa", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us aaa - wtm screening", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 272.73, "10th_percentile": 267.39, "90th_percentile": 278.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 677.47, "10th_percentile": 677.47, "90th_percentile": 677.47, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 260.74, "10th_percentile": 260.74, "90th_percentile": 273.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 260.74, "10th_percentile": 260.74, "90th_percentile": 260.74, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 269.38, "10th_percentile": 262.01, "90th_percentile": 273.80, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 260.74, "10th_percentile": 260.74, "90th_percentile": 260.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.52, "10th_percentile": 182.52, "90th_percentile": 182.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam abdo back wall lim", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us aorta", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 730.02, "10th_percentile": 730.02, "90th_percentile": 730.02, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 730.02, "10th_percentile": 730.02, "90th_percentile": 730.02, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.06, "10th_percentile": 173.22, "90th_percentile": 258.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 707.28, "10th_percentile": 545.41, "90th_percentile": 747.23, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 146.40, "10th_percentile": 48.40, "90th_percentile": 273.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 92.52, "10th_percentile": 86.22, "90th_percentile": 97.16, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 245.90, "10th_percentile": 238.40, "90th_percentile": 255.90, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 208.59, "10th_percentile": 203.21, "90th_percentile": 211.11, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 182.52, "10th_percentile": 161.15, "90th_percentile": 273.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.14, "10th_percentile": 225.87, "90th_percentile": 269.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us < 14 wks single fetus", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pregnant uterus < 14 weeks", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us < 14 wks addl fetus", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.25, "discounted_cash": 92.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us uterus ea add'l gest <14 wk", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.25, "discounted_cash": 92.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us >= 14 wks sngl fetus", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pregnant uterus > 14 weeks", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us >= 14 wks addl fetus", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.00, "discounted_cash": 181.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us uterus ea add'l gest >14 wk", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.00, "discounted_cash": 181.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us limited fetus(s)", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pregnancy uterus limited", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us follow-up per fetus", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pregnant uterus follow up", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transvaginal us obstetric", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us transvaginal preg uterus", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fetal biophys profile w/nst", "code_information": [ { "code": "76818", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fetal biophysical profile", "code_information": [ { "code": "76818", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transvaginal us non-ob", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us transvaginal non-ob", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 641.79, "10th_percentile": 587.95, "90th_percentile": 752.72, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.42, "10th_percentile": 88.75, "90th_percentile": 92.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.06, "10th_percentile": 232.52, "90th_percentile": 257.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 173.40, "10th_percentile": 158.80, "90th_percentile": 237.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 830.23, "10th_percentile": 830.23, "90th_percentile": 830.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 830.23, "10th_percentile": 830.23, "90th_percentile": 830.23, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us exam pelvic complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pelvic comp non-ob", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "1 through 10", "median_amount": 606.62, "10th_percentile": 583.45, "90th_percentile": 755.44, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.72, "10th_percentile": 65.46, "90th_percentile": 201.98, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.84, "10th_percentile": 92.98, "90th_percentile": 96.70, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 279.39, "10th_percentile": 279.39, "90th_percentile": 279.39, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.28, "10th_percentile": 164.28, "90th_percentile": 164.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam pelvic limited", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pelvis follow up", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 272.63, "maximum": 799.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 799.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 272.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam scrotum", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us scrotum and content", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 244.39, "10th_percentile": 160.64, "90th_percentile": 264.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 374.14, "10th_percentile": 79.47, "90th_percentile": 668.82, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 260.74, "10th_percentile": 260.74, "90th_percentile": 260.74, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 199.63, "10th_percentile": 146.60, "90th_percentile": 252.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.06, "10th_percentile": 71.88, "90th_percentile": 90.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 248.40, "10th_percentile": 248.40, "90th_percentile": 248.40, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 219.04, "10th_percentile": 219.04, "90th_percentile": 219.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 664.18, "10th_percentile": 664.18, "90th_percentile": 664.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 664.18, "10th_percentile": 664.18, "90th_percentile": 664.18, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us lmtd jt/nonvasc xtr strux", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.33, "10th_percentile": 88.33, "90th_percentile": 88.33, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 262.50, "10th_percentile": 261.77, "90th_percentile": 263.22, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us extremity non vascular", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 266.06, "10th_percentile": 266.06, "90th_percentile": 266.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 644.54, "10th_percentile": 619.92, "90th_percentile": 695.84, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 139.87, "10th_percentile": 90.87, "90th_percentile": 246.42, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.40, "10th_percentile": 146.40, "90th_percentile": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.52, "10th_percentile": 89.59, "90th_percentile": 95.77, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 191.66, "10th_percentile": 169.76, "90th_percentile": 191.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.14, "10th_percentile": 245.14, "90th_percentile": 245.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 790.62, "10th_percentile": 790.62, "90th_percentile": 790.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 790.62, "10th_percentile": 790.62, "90th_percentile": 790.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "#name?", "code_information": [ { "code": "76937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 52.50, "discounted_cash": 31.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us guide vascular access", "code_information": [ { "code": "76937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 52.50, "discounted_cash": 31.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echo guide for biopsy", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.50, "discounted_cash": 119.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us guidance cyst aspiration", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.50, "discounted_cash": 119.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.23, "10th_percentile": 49.23, "90th_percentile": 49.23, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.22, "10th_percentile": 37.40, "90th_percentile": 47.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.99, "10th_percentile": 53.99, "90th_percentile": 53.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 182.86, "10th_percentile": 182.86, "90th_percentile": 182.86, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 182.86, "10th_percentile": 182.86, "90th_percentile": 182.86, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fluoroguide for vein device", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.75, "discounted_cash": 236.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prof fluoroguide vein device", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 291.75, "discounted_cash": 175.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoroscopic guide for cva", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.75, "discounted_cash": 236.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle localization by xray", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 417.00, "discounted_cash": 250.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 40.87, "10th_percentile": 23.79, "90th_percentile": 42.80, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.49, "10th_percentile": 91.21, "90th_percentile": 295.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle localization by xray", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.75, "discounted_cash": 41.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoro guidance bx aspir inj", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 417.00, "discounted_cash": 250.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.51, "10th_percentile": 60.27, "90th_percentile": 139.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.49, "10th_percentile": 96.49, "90th_percentile": 96.49, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoroguide for spine inject", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 358.25, "discounted_cash": 214.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoro guide for spine inject", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74.50, "discounted_cash": 44.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoro guide for spine inject", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 358.25, "discounted_cash": 214.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breast tomosynthesis uni", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx tomosynthesis mammo left", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tomosynthesis mammo right", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tomosynthesis mammo right", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.30, "10th_percentile": 40.36, "90th_percentile": 48.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breast tomosynthesis bi", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tomosynthesis mammo bilat", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 34.45, "10th_percentile": 34.45, "90th_percentile": 34.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 34.45, "10th_percentile": 34.45, "90th_percentile": 34.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.47, "10th_percentile": 37.47, "90th_percentile": 37.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breast tomosynthesis bi", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.50, "discounted_cash": 93.90, "minimum": 46.44, "maximum": 136.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 136.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 136.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 46.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scrn breast tomosynthesis uni", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "52", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scrn breast tomosynthesis bil", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.50, "discounted_cash": 93.90, "minimum": 19.88, "maximum": 58.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 58.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 58.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx mammo incl cad uni", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 541.75, "discounted_cash": 325.05, "minimum": 108.55, "maximum": 318.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 318.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 318.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 108.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx mammo w cad uni left", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 541.75, "discounted_cash": 325.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 167.94, "10th_percentile": 167.94, "90th_percentile": 167.94, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 293.02, "10th_percentile": 197.83, "90th_percentile": 388.22, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 313.82, "10th_percentile": 313.82, "90th_percentile": 313.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.75, "10th_percentile": 98.75, "90th_percentile": 106.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 109.69, "10th_percentile": 109.69, "90th_percentile": 109.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 109.69, "10th_percentile": 109.69, "90th_percentile": 109.69, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dx mammo w cad uni right", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 541.75, "discounted_cash": 325.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 159.88, "10th_percentile": 159.88, "90th_percentile": 166.33, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 350.43, "10th_percentile": 158.00, "90th_percentile": 396.22, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.75, "10th_percentile": 96.38, "90th_percentile": 98.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.78, "10th_percentile": 155.76, "90th_percentile": 184.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx mammo w cad uni right", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 541.75, "discounted_cash": 325.05, "minimum": 72.90, "maximum": 213.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 213.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 213.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 72.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx mammo incl cad bi", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.25, "discounted_cash": 414.15, "minimum": 136.44, "maximum": 400.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 400.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 400.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 136.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx mammo incl cad bil", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 690.25, "discounted_cash": 414.15, "minimum": 92.77, "maximum": 272.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 213.98, "10th_percentile": 213.98, "90th_percentile": 213.98, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 272.00, "count": "1 through 10", "median_amount": 493.64, "10th_percentile": 384.90, "90th_percentile": 562.33, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 272.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 457.14, "10th_percentile": 457.14, "90th_percentile": 457.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.63, "10th_percentile": 71.21, "90th_percentile": 74.05, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 92.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 209.70, "10th_percentile": 209.70, "90th_percentile": 209.70, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.83, "10th_percentile": 58.45, "90th_percentile": 136.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 164.28, "10th_percentile": 164.28, "90th_percentile": 164.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 164.28, "10th_percentile": 164.28, "90th_percentile": 164.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 178.78, "10th_percentile": 178.78, "90th_percentile": 178.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scr mammo bi incl cad", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 694.75, "discounted_cash": 416.85, "minimum": 110.39, "maximum": 323.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 323.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 323.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.08, "10th_percentile": 72.08, "90th_percentile": 72.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 110.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scr mammo uni w cad", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 608.00, "discounted_cash": 364.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "52", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 180.31, "10th_percentile": 123.26, "90th_percentile": 184.71, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.84, "10th_percentile": 75.84, "90th_percentile": 77.84, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.48, "10th_percentile": 188.48, "90th_percentile": 188.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.27, "10th_percentile": 61.00, "90th_percentile": 62.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 206.72, "10th_percentile": 206.72, "90th_percentile": 206.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scr mammo bil w cad", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 694.75, "discounted_cash": 416.85, "minimum": 76.62, "maximum": 224.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 625.28, "10th_percentile": 367.36, "90th_percentile": 625.28, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 625.28, "10th_percentile": 367.36, "90th_percentile": 625.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 215.37, "10th_percentile": 205.07, "90th_percentile": 215.37, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 224.63, "count": "97", "median_amount": 572.27, "10th_percentile": 538.05, "90th_percentile": 584.52, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 224.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 211.06, "10th_percentile": 200.97, "90th_percentile": 211.06, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 211.06, "10th_percentile": 207.02, "90th_percentile": 661.30, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "96", "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 77.84, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 76.62, "count": "23", "median_amount": 203.01, "10th_percentile": 203.01, "90th_percentile": 213.22, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 204.26, "10th_percentile": 200.97, "90th_percentile": 215.37, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 60.68, "10th_percentile": 60.68, "90th_percentile": 62.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 640.00, "10th_percentile": 224.91, "90th_percentile": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 640.00, "10th_percentile": 224.91, "90th_percentile": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 236.22, "10th_percentile": 224.91, "90th_percentile": 236.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 640.00, "10th_percentile": 609.37, "90th_percentile": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 640.00, "10th_percentile": 609.37, "90th_percentile": 640.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-rays for bone age", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr bone age study", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 197.12, "10th_percentile": 197.12, "90th_percentile": 197.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-rays bone survey complete", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr skeletal survey", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dxa bone density axial", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dxa axial skeleton", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 171.12, "10th_percentile": 171.12, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "12", "median_amount": 464.41, "10th_percentile": 180.33, "90th_percentile": 487.78, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "57", "median_amount": 176.13, "10th_percentile": 95.63, "90th_percentile": 444.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 251.85, "10th_percentile": 191.27, "90th_percentile": 345.31, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "58", "median_amount": 167.70, "10th_percentile": 162.29, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "19", "median_amount": 169.41, "10th_percentile": 169.41, "90th_percentile": 177.93, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.13, "10th_percentile": 167.70, "90th_percentile": 179.72, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 117.39, "10th_percentile": 105.68, "90th_percentile": 176.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 534.07, "10th_percentile": 534.07, "90th_percentile": 534.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 534.07, "10th_percentile": 534.07, "90th_percentile": 534.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 197.12, "10th_percentile": 175.69, "90th_percentile": 197.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dxa bone density/peripheral", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dxa appendicular skeleton", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 126.71, "10th_percentile": 126.71, "90th_percentile": 126.71, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fracture assessment via dxa", "code_information": [ { "code": "77086", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dxa vertebral fx assessment", "code_information": [ { "code": "77086", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroid uptake measurement", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm thyroid uptake single deter", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroid imaging w/blood flow", "code_information": [ { "code": "78013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm thyroid imaging only", "code_information": [ { "code": "78013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroid imaging w/blood flow", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm thyroid image w uptake mult", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "1 through 10", "median_amount": 1296.54, "10th_percentile": 1296.54, "90th_percentile": 1296.54, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "1 through 10", "median_amount": 513.06, "10th_percentile": 513.06, "90th_percentile": 513.06, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Parathyroid planar imaging", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm parathyroid imaging", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 494.10, "10th_percentile": 494.10, "90th_percentile": 494.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spleen imaging", "code_information": [ { "code": "78185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm spleen imaging only", "code_information": [ { "code": "78185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lymph system imaging", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm lymphatic imaging", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Liver imaging", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm liver imaging static only", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Liver and spleen imaging", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm liver & spleen imaging stat", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatobiliary system imaging", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm hepatobiliary duct imaging", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 180.21, "10th_percentile": 180.21, "90th_percentile": 180.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 507.88, "10th_percentile": 507.88, "90th_percentile": 507.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatobil syst image w/drug", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm hepatobilary image w pharm", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 422.70, "10th_percentile": 402.70, "90th_percentile": 422.70, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "1 through 10", "median_amount": 1547.69, "10th_percentile": 967.53, "90th_percentile": 1711.01, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 491.09, "10th_percentile": 357.77, "90th_percentile": 1359.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 222.77, "10th_percentile": 208.60, "90th_percentile": 227.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 461.48, "10th_percentile": 415.33, "90th_percentile": 461.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 446.46, "10th_percentile": 262.02, "90th_percentile": 510.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1522.93, "10th_percentile": 1522.93, "90th_percentile": 1522.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1522.93, "10th_percentile": 1522.93, "90th_percentile": 1522.93, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gastroesophageal reflux exam", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm gastric reflux study", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gastric emptying imag study", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm gastric empting study", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acute gi blood loss imaging", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm acute gi blood loss imaging", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meckels divert exam", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm intestine imaging meckles", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging limited area", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone image limited area", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 374.72, "10th_percentile": 374.72, "90th_percentile": 374.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging multiple areas", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone imaging multiple", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging whole body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone imaging whole body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 519.88, "10th_percentile": 519.88, "90th_percentile": 519.88, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 180.21, "10th_percentile": 160.86, "90th_percentile": 180.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging 3 phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone image three phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 253.24, "10th_percentile": 253.24, "90th_percentile": 253.24, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 172.03, "10th_percentile": 158.37, "90th_percentile": 180.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 338.56, "10th_percentile": 299.86, "90th_percentile": 338.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 454.84, "10th_percentile": 443.99, "90th_percentile": 465.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ht muscle image spect sing", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5794.25, "discounted_cash": 3476.55, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm myocardial perfusion single", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5794.25, "discounted_cash": 3476.55, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Single myocardial perf interp", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.50, "discounted_cash": 89.70, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ht muscle image spect mult", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5794.25, "discounted_cash": 3476.55, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "46", "median_amount": 567.84, "10th_percentile": 65.61, "90th_percentile": 624.62, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1529.45, "10th_percentile": 1529.45, "90th_percentile": 1529.45, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Multiple myocardial perf inter", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 173.75, "discounted_cash": 104.25, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Myocardial perfusion multiple", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5794.25, "discounted_cash": 3476.55, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4595.35, "10th_percentile": 4099.78, "90th_percentile": 5090.94, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4595.35, "10th_percentile": 4099.78, "90th_percentile": 5090.94, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 1471.22, "10th_percentile": 1423.29, "90th_percentile": 1582.00, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "39", "median_amount": 4057.87, "10th_percentile": 2155.37, "90th_percentile": 4806.92, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "84", "median_amount": 2473.96, "10th_percentile": 1681.89, "90th_percentile": 3216.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2448.53, "10th_percentile": 1658.13, "90th_percentile": 3286.87, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 594.87, "10th_percentile": 546.20, "90th_percentile": 594.87, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "14", "median_amount": 1693.55, "10th_percentile": 1686.55, "90th_percentile": 1752.85, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 1422.61, "10th_percentile": 1201.92, "90th_percentile": 1646.22, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 1173.52, "10th_percentile": 1056.18, "90th_percentile": 1750.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4270.13, "10th_percentile": 4270.13, "90th_percentile": 4270.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4270.13, "10th_percentile": 4270.13, "90th_percentile": 4270.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 1496.04, "10th_percentile": 956.04, "90th_percentile": 1576.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heart infarct image", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mi imaging", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gated heart planar single", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm cardiac blood pool imaging", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung ventilation imaging", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm pulmonary vent imaging", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung perfusion imaging", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm pulmonary perfusion imaging", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung ventilat&perfus imaging", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm pulmonary vent/perfusion", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 512.50, "10th_percentile": 512.50, "90th_percentile": 512.50, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1802.62, "10th_percentile": 1802.62, "90th_percentile": 1802.62, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung perf&ventilat diferentl", "code_information": [ { "code": "78598", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm lung vent/perfusion differe", "code_information": [ { "code": "78598", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brain image w/flow 4 + views", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brain imaging comp w vascular", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brain flow imaging only", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brain imaging vascula flw only", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kidney imaging morphol", "code_information": [ { "code": "78700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm renal function study", "code_information": [ { "code": "78700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kidney imaging with flow", "code_information": [ { "code": "78701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm renal flow study", "code_information": [ { "code": "78701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "K flow/funct image w/o drug", "code_information": [ { "code": "78707", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm kidney image w vas flw func", "code_information": [ { "code": "78707", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "K flow/funct image w/drug", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm kidney imaging w vas flw ph", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "K flow/funct image multiple", "code_information": [ { "code": "78709", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm kidney image muleft w/wo", "code_information": [ { "code": "78709", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2170.00, "discounted_cash": 1302.00, "minimum": 478.80, "maximum": 1403.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1403.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 478.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Testicular imaging w/flow", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm testicular imaging w vas fl", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1671.75, "discounted_cash": 1003.05, "minimum": 357.43, "maximum": 1047.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1047.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 357.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet image ltd area", "code_information": [ { "code": "78811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6146.25, "discounted_cash": 3687.75, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet imaging ltd area", "code_information": [ { "code": "78811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6146.25, "discounted_cash": 3687.75, "minimum": 1161.24, "maximum": 3404.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3404.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1161.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet image skull-thigh", "code_information": [ { "code": "78812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet imaging skull base-thigh", "code_information": [ { "code": "78812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet image full body", "code_information": [ { "code": "78813", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet imaging whole body", "code_information": [ { "code": "78813", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet image w/ct lmtd", "code_information": [ { "code": "78814", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet imaging w/ct limited", "code_information": [ { "code": "78814", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet image w/ct skull-thigh", "code_information": [ { "code": "78815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1954.66, "10th_percentile": 1807.92, "90th_percentile": 2101.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "1 through 10", "median_amount": 4994.31, "10th_percentile": 3430.04, "90th_percentile": 5641.24, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1295.03, "10th_percentile": 1295.03, "90th_percentile": 1295.03, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1233.44, "10th_percentile": 1233.44, "90th_percentile": 1233.44, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 675.91, "10th_percentile": 656.59, "90th_percentile": 716.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "1 through 10", "median_amount": 1966.28, "10th_percentile": 1845.95, "90th_percentile": 2086.61, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1988.07, "10th_percentile": 1988.07, "90th_percentile": 1988.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1327.03, "10th_percentile": 1215.27, "90th_percentile": 1396.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet imaging wct skull to thigh", "code_information": [ { "code": "78815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1954.66, "10th_percentile": 1807.92, "90th_percentile": 2101.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "1 through 10", "median_amount": 4994.31, "10th_percentile": 3430.04, "90th_percentile": 5641.24, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1295.03, "10th_percentile": 1295.03, "90th_percentile": 1295.03, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1233.44, "10th_percentile": 1233.44, "90th_percentile": 1233.44, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 675.91, "10th_percentile": 656.59, "90th_percentile": 716.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "1 through 10", "median_amount": 1966.28, "10th_percentile": 1845.95, "90th_percentile": 2086.61, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1988.07, "10th_percentile": 1988.07, "90th_percentile": 1988.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1327.03, "10th_percentile": 1215.27, "90th_percentile": 1396.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet image w/ct full body", "code_information": [ { "code": "78816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1257.19, "10th_percentile": 1257.19, "90th_percentile": 1257.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pet imaging w/ct whole body", "code_information": [ { "code": "78816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6897.00, "discounted_cash": 4138.20, "minimum": 1297.43, "maximum": 3803.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3803.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1297.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1257.19, "10th_percentile": 1257.19, "90th_percentile": 1257.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Erpanel(basic metabolic panel)", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 96.80, "10th_percentile": 59.04, "90th_percentile": 134.56, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 96.80, "10th_percentile": 59.04, "90th_percentile": 134.56, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 47.20, "10th_percentile": 37.76, "90th_percentile": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.26, "10th_percentile": 46.26, "90th_percentile": 46.26, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "296", "median_amount": 149.20, "10th_percentile": 28.83, "90th_percentile": 156.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 149.20, "10th_percentile": 39.45, "90th_percentile": 156.80, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "399", "median_amount": 47.04, "10th_percentile": 46.26, "90th_percentile": 48.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "57", "median_amount": 48.61, "10th_percentile": 38.13, "90th_percentile": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "230", "median_amount": 48.61, "10th_percentile": 46.26, "90th_percentile": 48.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.82, "10th_percentile": 140.25, "90th_percentile": 147.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.82, "10th_percentile": 140.25, "90th_percentile": 147.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "47", "median_amount": 43.52, "10th_percentile": 38.08, "90th_percentile": 54.40, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 140.25, "10th_percentile": 99.48, "90th_percentile": 147.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 140.25, "10th_percentile": 99.48, "90th_percentile": 147.39, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Metabolic panel total ca", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 96.80, "10th_percentile": 59.04, "90th_percentile": 134.56, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 96.80, "10th_percentile": 59.04, "90th_percentile": 134.56, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 47.20, "10th_percentile": 37.76, "90th_percentile": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.26, "10th_percentile": 46.26, "90th_percentile": 46.26, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "296", "median_amount": 149.20, "10th_percentile": 28.83, "90th_percentile": 156.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 149.20, "10th_percentile": 39.45, "90th_percentile": 156.80, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "399", "median_amount": 47.04, "10th_percentile": 46.26, "90th_percentile": 48.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "57", "median_amount": 48.61, "10th_percentile": 38.13, "90th_percentile": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "230", "median_amount": 48.61, "10th_percentile": 46.26, "90th_percentile": 48.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.82, "10th_percentile": 140.25, "90th_percentile": 147.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.82, "10th_percentile": 140.25, "90th_percentile": 147.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "47", "median_amount": 43.52, "10th_percentile": 38.08, "90th_percentile": 54.40, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 140.25, "10th_percentile": 99.48, "90th_percentile": 147.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 140.25, "10th_percentile": 99.48, "90th_percentile": 147.39, "methodology": "percent of total billed charges" } ] } ] }, { "description": "General health panel", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 483.00, "discounted_cash": 289.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 156.40, "10th_percentile": 156.40, "90th_percentile": 156.40, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrolyte panel", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.00, "discounted_cash": 75.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lytes (electrolytes panel)", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.00, "discounted_cash": 75.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Comprehen metabolic panel", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.50, "discounted_cash": 146.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "21", "median_amount": 199.15, "10th_percentile": 175.32, "90th_percentile": 219.15, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "21", "median_amount": 199.15, "10th_percentile": 175.32, "90th_percentile": 219.15, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "267", "median_amount": 71.84, "10th_percentile": 57.47, "90th_percentile": 75.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.99, "10th_percentile": 70.41, "90th_percentile": 74.59, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1060", "median_amount": 227.11, "10th_percentile": 92.04, "90th_percentile": 238.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "73", "median_amount": 195.55, "10th_percentile": 96.66, "90th_percentile": 238.63, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1248", "median_amount": 71.59, "10th_percentile": 70.40, "90th_percentile": 73.98, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "162", "median_amount": 73.98, "10th_percentile": 56.32, "90th_percentile": 75.49, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "745", "median_amount": 73.99, "10th_percentile": 70.41, "90th_percentile": 73.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "24", "median_amount": 213.49, "10th_percentile": 66.23, "90th_percentile": 224.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "24", "median_amount": 213.49, "10th_percentile": 66.23, "90th_percentile": 224.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "244", "median_amount": 66.23, "10th_percentile": 57.95, "90th_percentile": 82.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "46", "median_amount": 224.31, "10th_percentile": 143.07, "90th_percentile": 224.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "46", "median_amount": 224.31, "10th_percentile": 143.07, "90th_percentile": 224.31, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Comprehensive metabolic panel", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.50, "discounted_cash": 146.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "21", "median_amount": 199.15, "10th_percentile": 175.32, "90th_percentile": 219.15, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "21", "median_amount": 199.15, "10th_percentile": 175.32, "90th_percentile": 219.15, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "267", "median_amount": 71.84, "10th_percentile": 57.47, "90th_percentile": 75.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.99, "10th_percentile": 70.41, "90th_percentile": 74.59, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1060", "median_amount": 227.11, "10th_percentile": 92.04, "90th_percentile": 238.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "73", "median_amount": 195.55, "10th_percentile": 96.66, "90th_percentile": 238.63, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1248", "median_amount": 71.59, "10th_percentile": 70.40, "90th_percentile": 73.98, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "162", "median_amount": 73.98, "10th_percentile": 56.32, "90th_percentile": 75.49, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "745", "median_amount": 73.99, "10th_percentile": 70.41, "90th_percentile": 73.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "24", "median_amount": 213.49, "10th_percentile": 66.23, "90th_percentile": 224.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "24", "median_amount": 213.49, "10th_percentile": 66.23, "90th_percentile": 224.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "244", "median_amount": 66.23, "10th_percentile": 57.95, "90th_percentile": 82.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "46", "median_amount": 224.31, "10th_percentile": 143.07, "90th_percentile": 224.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "46", "median_amount": 224.31, "10th_percentile": 143.07, "90th_percentile": 224.31, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Obstetric panel", "code_information": [ { "code": "80055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 858.25, "discounted_cash": 514.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prenatal profile b", "code_information": [ { "code": "80055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 858.25, "discounted_cash": 514.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipid panel", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.50, "discounted_cash": 144.30, "minimum": 13.26, "maximum": 38.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 206.10, "10th_percentile": 173.16, "90th_percentile": 216.45, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 206.10, "10th_percentile": 173.16, "90th_percentile": 216.45, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "84", "median_amount": 70.99, "10th_percentile": 56.79, "90th_percentile": 74.56, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 38.87, "count": "265", "median_amount": 192.65, "10th_percentile": 154.12, "90th_percentile": 203.14, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 38.87, "count": "1 through 10", "median_amount": 163.75, "10th_percentile": 162.24, "90th_percentile": 186.87, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.58, "10th_percentile": 69.58, "90th_percentile": 69.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "262", "median_amount": 131.59, "10th_percentile": 31.54, "90th_percentile": 235.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 158.85, "10th_percentile": 12.25, "90th_percentile": 217.45, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "321", "median_amount": 70.71, "10th_percentile": 69.57, "90th_percentile": 73.07, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.26, "count": "63", "median_amount": 70.28, "10th_percentile": 70.28, "90th_percentile": 73.81, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 73.07, "10th_percentile": 69.57, "90th_percentile": 74.56, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "147", "median_amount": 73.07, "10th_percentile": 69.58, "90th_percentile": 73.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "11", "median_amount": 210.95, "10th_percentile": 134.78, "90th_percentile": 221.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "11", "median_amount": 210.95, "10th_percentile": 134.78, "90th_percentile": 221.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "109", "median_amount": 65.42, "10th_percentile": 62.29, "90th_percentile": 81.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "18", "median_amount": 210.95, "10th_percentile": 140.05, "90th_percentile": 221.55, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "18", "median_amount": 210.95, "10th_percentile": 140.05, "90th_percentile": 221.55, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Renal function panel", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.25, "discounted_cash": 93.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.44, "10th_percentile": 43.66, "90th_percentile": 48.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.05, "10th_percentile": 26.42, "90th_percentile": 165.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "50", "median_amount": 45.94, "10th_percentile": 45.19, "90th_percentile": 47.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.44, "10th_percentile": 45.19, "90th_percentile": 48.44, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 47.48, "10th_percentile": 45.19, "90th_percentile": 47.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.84, "10th_percentile": 37.72, "90th_percentile": 41.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.94, "10th_percentile": 143.94, "90th_percentile": 143.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.94, "10th_percentile": 143.94, "90th_percentile": 143.94, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Renal panel", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.25, "discounted_cash": 93.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.44, "10th_percentile": 43.66, "90th_percentile": 48.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.05, "10th_percentile": 26.42, "90th_percentile": 165.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "50", "median_amount": 45.94, "10th_percentile": 45.19, "90th_percentile": 47.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.44, "10th_percentile": 45.19, "90th_percentile": 48.44, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 47.48, "10th_percentile": 45.19, "90th_percentile": 47.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.84, "10th_percentile": 37.72, "90th_percentile": 41.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.94, "10th_percentile": 143.94, "90th_percentile": 143.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.94, "10th_percentile": 143.94, "90th_percentile": 143.94, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acute hepatitis panel", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 513.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 212.04, "10th_percentile": 212.04, "90th_percentile": 212.04, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.38, "10th_percentile": 247.38, "90th_percentile": 247.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 538.54, "10th_percentile": 209.80, "90th_percentile": 797.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 251.37, "10th_percentile": 248.17, "90th_percentile": 251.37, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 259.75, "10th_percentile": 249.85, "90th_percentile": 259.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 232.56, "10th_percentile": 176.64, "90th_percentile": 239.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis profile", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 513.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 212.04, "10th_percentile": 212.04, "90th_percentile": 212.04, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.38, "10th_percentile": 247.38, "90th_percentile": 247.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 538.54, "10th_percentile": 209.80, "90th_percentile": 797.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 251.37, "10th_percentile": 248.17, "90th_percentile": 251.37, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 259.75, "10th_percentile": 249.85, "90th_percentile": 259.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 232.56, "10th_percentile": 176.64, "90th_percentile": 239.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatic function panel", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.75, "discounted_cash": 88.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.39, "10th_percentile": 34.66, "90th_percentile": 45.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.46, "10th_percentile": 42.46, "90th_percentile": 42.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 115.05, "10th_percentile": 23.69, "90th_percentile": 143.81, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.72, "10th_percentile": 65.72, "90th_percentile": 65.72, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 42.45, "10th_percentile": 42.45, "90th_percentile": 44.58, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.97, "10th_percentile": 42.75, "90th_percentile": 45.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 43.53, "10th_percentile": 42.46, "90th_percentile": 44.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.52, "10th_percentile": 39.92, "90th_percentile": 49.90, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amikacin peak", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 162.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 162.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay carbamazepine total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 261.75, "discounted_cash": 157.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 244.26, "10th_percentile": 244.26, "90th_percentile": 244.26, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.72, "10th_percentile": 75.72, "90th_percentile": 76.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carbamazepine total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 261.75, "discounted_cash": 157.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 244.26, "10th_percentile": 244.26, "90th_percentile": 244.26, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.72, "10th_percentile": 75.72, "90th_percentile": 76.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.25, "discounted_cash": 194.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 271.05, "10th_percentile": 222.67, "90th_percentile": 317.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug assay cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.25, "discounted_cash": 194.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 271.05, "10th_percentile": 222.67, "90th_percentile": 317.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of digoxin total", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.21, "10th_percentile": 59.21, "90th_percentile": 59.21, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 222.70, "10th_percentile": 222.70, "90th_percentile": 222.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.37, "10th_percentile": 70.20, "90th_percentile": 72.53, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.53, "10th_percentile": 72.53, "90th_percentile": 72.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay dipropylace acd tot", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.50, "discounted_cash": 146.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 227.11, "10th_percentile": 227.11, "90th_percentile": 227.11, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.59, "10th_percentile": 70.40, "90th_percentile": 73.98, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.99, "10th_percentile": 70.41, "90th_percentile": 73.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.23, "10th_percentile": 66.23, "90th_percentile": 66.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay dipropylacetic acd tot", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.50, "discounted_cash": 146.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 227.11, "10th_percentile": 227.11, "90th_percentile": 227.11, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.59, "10th_percentile": 70.40, "90th_percentile": 73.98, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.99, "10th_percentile": 70.41, "90th_percentile": 73.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.23, "10th_percentile": 66.23, "90th_percentile": 66.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.50, "discounted_cash": 176.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gentamicin peak level", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.50, "discounted_cash": 176.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screen quant gabapentin", "code_information": [ { "code": "80171", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neurontin level", "code_information": [ { "code": "80171", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drg scrn quan lamotrigine", "code_information": [ { "code": "80175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.25, "discounted_cash": 142.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screen quan lamotrigine", "code_information": [ { "code": "80175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.25, "discounted_cash": 142.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lidocaine", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.00, "discounted_cash": 158.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.00, "discounted_cash": 158.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug scrn quan levetiracetam", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 432.75, "discounted_cash": 259.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 71.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.57, "10th_percentile": 34.70, "90th_percentile": 36.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lithium level", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 71.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.57, "10th_percentile": 34.70, "90th_percentile": 36.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug scrn quan mycophenolate", "code_information": [ { "code": "80180", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 432.75, "discounted_cash": 259.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug scrn quant oxcarbazepin", "code_information": [ { "code": "80183", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.25, "discounted_cash": 142.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of phenobarbital", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 165.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenobarbital", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 165.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of phenytoin total", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.25, "discounted_cash": 142.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenytoin total", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.25, "discounted_cash": 142.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of primidone", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 298.25, "discounted_cash": 178.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Primidone (mysoline)", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 298.25, "discounted_cash": 178.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of procainamide", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 301.00, "discounted_cash": 180.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procainamide with metabolites", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 301.00, "discounted_cash": 180.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of quinidine", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.25, "discounted_cash": 157.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Quinidine level", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.25, "discounted_cash": 157.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of sirolimus", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.50, "discounted_cash": 147.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sirolimus rapamune level", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.50, "discounted_cash": 147.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of tacrolimus", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.50, "discounted_cash": 147.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 230.05, "10th_percentile": 230.05, "90th_percentile": 241.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.31, "10th_percentile": 71.31, "90th_percentile": 119.82, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.32, "10th_percentile": 71.32, "90th_percentile": 74.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 83.81, "10th_percentile": 63.86, "90th_percentile": 83.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tacrolimus level", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.50, "discounted_cash": 147.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 230.05, "10th_percentile": 230.05, "90th_percentile": 241.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.31, "10th_percentile": 71.31, "90th_percentile": 119.82, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.32, "10th_percentile": 71.32, "90th_percentile": 74.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 83.81, "10th_percentile": 63.86, "90th_percentile": 83.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of theophylline", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 254.25, "discounted_cash": 152.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Theophylline level", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 254.25, "discounted_cash": 152.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of tobramycin", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 290.00, "discounted_cash": 174.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tobramycin level", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 290.00, "discounted_cash": 174.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.92, "10th_percentile": 62.92, "90th_percentile": 62.92, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.92, "10th_percentile": 62.92, "90th_percentile": 62.92, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of vancomycin", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.50, "discounted_cash": 146.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.40, "10th_percentile": 68.14, "90th_percentile": 100.72, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.99, "10th_percentile": 71.13, "90th_percentile": 73.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin level", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.50, "discounted_cash": 146.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.40, "10th_percentile": 68.14, "90th_percentile": 100.72, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.99, "10th_percentile": 71.13, "90th_percentile": 73.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antidepressant not specified", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Quantitative assay drug", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screen non tlc devices", "code_information": [ { "code": "80305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 226.75, "discounted_cash": 136.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.29, "10th_percentile": 59.77, "90th_percentile": 70.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.89, "10th_percentile": 68.89, "90th_percentile": 68.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 216.82, "10th_percentile": 47.07, "90th_percentile": 222.21, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 222.21, "10th_percentile": 222.21, "90th_percentile": 222.21, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 66.67, "10th_percentile": 63.44, "90th_percentile": 66.67, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.71, "10th_percentile": 62.71, "90th_percentile": 62.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 68.89, "10th_percentile": 65.55, "90th_percentile": 68.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 61.68, "10th_percentile": 58.69, "90th_percentile": 75.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 208.88, "10th_percentile": 208.88, "90th_percentile": 208.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 208.88, "10th_percentile": 208.88, "90th_percentile": 208.88, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Drug test prsmv dir opt obs", "code_information": [ { "code": "80305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 226.75, "discounted_cash": 136.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.29, "10th_percentile": 59.77, "90th_percentile": 70.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.89, "10th_percentile": 68.89, "90th_percentile": 68.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 216.82, "10th_percentile": 47.07, "90th_percentile": 222.21, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 222.21, "10th_percentile": 222.21, "90th_percentile": 222.21, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 66.67, "10th_percentile": 63.44, "90th_percentile": 66.67, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.71, "10th_percentile": 62.71, "90th_percentile": 62.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 68.89, "10th_percentile": 65.55, "90th_percentile": 68.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 61.68, "10th_percentile": 58.69, "90th_percentile": 75.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 208.88, "10th_percentile": 208.88, "90th_percentile": 208.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 208.88, "10th_percentile": 208.88, "90th_percentile": 208.88, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C-o-c drug screen", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.75, "discounted_cash": 101.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.66, "10th_percentile": 8.66, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.60, "10th_percentile": 6.76, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.67, "10th_percentile": 8.63, "90th_percentile": 8.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test prsmv chem anlyzr", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.75, "discounted_cash": 101.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.66, "10th_percentile": 8.66, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.60, "10th_percentile": 6.76, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.67, "10th_percentile": 8.63, "90th_percentile": 8.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screen quantalcohols", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 201.00, "discounted_cash": 120.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 185.16, "10th_percentile": 185.16, "90th_percentile": 185.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 185.16, "10th_percentile": 185.16, "90th_percentile": 185.16, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Alcohols biomarkers 1or 2", "code_information": [ { "code": "80321", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.00, "discounted_cash": 120.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phosphatidylethanol", "code_information": [ { "code": "80321", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.00, "discounted_cash": 120.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alkaloids nos", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 90.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine and metabol", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 90.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amphetamines ms ur", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 182.50, "discounted_cash": 109.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screen amphetamines 1/2", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 182.50, "discounted_cash": 109.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amphetamines 3or 4", "code_information": [ { "code": "80325", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 269.75, "discounted_cash": 161.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.72, "10th_percentile": 91.72, "90th_percentile": 91.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amphetamines 5 or more", "code_information": [ { "code": "80326", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80326", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Analgesics non-opioid 1 or 2", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 411.75, "discounted_cash": 247.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 172.01, "10th_percentile": 172.01, "90th_percentile": 172.01, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 513.80, "10th_percentile": 513.80, "90th_percentile": 513.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 513.80, "10th_percentile": 513.80, "90th_percentile": 513.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Analgesics non-opioid 6/more", "code_information": [ { "code": "80331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antidepressants class 1 or 2", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antidepressants class 6/more", "code_information": [ { "code": "80334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antidepressant tricyclic 1/2", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 350.50, "discounted_cash": 210.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tricyclic & cyclicals 6/more", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 269.75, "discounted_cash": 161.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antidepressant not specified", "code_information": [ { "code": "80338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antiepileptics nos 7/more", "code_information": [ { "code": "80341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antipsychotics nos 1-3", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 315.75, "discounted_cash": 189.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antipsychotics nos 7/more", "code_information": [ { "code": "80344", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80344", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening barbiturates", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 269.75, "discounted_cash": 161.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Benzodiazepines1-12", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 374.50, "discounted_cash": 224.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Benzodiazepines 13 or more", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.00, "discounted_cash": 61.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.52, "10th_percentile": 4.37, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure flex 16 u", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.00, "discounted_cash": 61.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.52, "10th_percentile": 4.37, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening buprenorphine", "code_information": [ { "code": "80348", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 143.50, "discounted_cash": 86.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.46, "10th_percentile": 8.36, "90th_percentile": 8.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure flex 16 u", "code_information": [ { "code": "80348", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 143.50, "discounted_cash": 86.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.46, "10th_percentile": 8.36, "90th_percentile": 8.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cannabinoids natural", "code_information": [ { "code": "80349", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 269.75, "discounted_cash": 161.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.72, "10th_percentile": 74.22, "90th_percentile": 91.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 248.49, "10th_percentile": 248.49, "90th_percentile": 248.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 248.49, "10th_percentile": 248.49, "90th_percentile": 248.49, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Drug screening cocaine", "code_information": [ { "code": "80353", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 269.75, "discounted_cash": 161.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.49, "10th_percentile": 4.39, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening fentanyl", "code_information": [ { "code": "80354", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 329.50, "discounted_cash": 197.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl level", "code_information": [ { "code": "80354", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 329.50, "discounted_cash": 197.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gabapentin non-blood", "code_information": [ { "code": "80355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 72.00, "discounted_cash": 43.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 72.00, "discounted_cash": 43.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketamine and norketamine", "code_information": [ { "code": "80357", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80357", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening methadone", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.49, "10th_percentile": 4.39, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.49, "10th_percentile": 4.39, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylenedioxyamphetamines", "code_information": [ { "code": "80359", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 70.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80359", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 70.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylphenidate", "code_information": [ { "code": "80360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocodone level", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 419.00, "discounted_cash": 251.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.49, "10th_percentile": 4.39, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 248.49, "10th_percentile": 248.49, "90th_percentile": 248.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 248.49, "10th_percentile": 248.49, "90th_percentile": 248.49, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Opiates 1 or more", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 419.00, "discounted_cash": 251.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.49, "10th_percentile": 4.39, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 248.49, "10th_percentile": 248.49, "90th_percentile": 248.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 248.49, "10th_percentile": 248.49, "90th_percentile": 248.49, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Opioid &opiate analog 5/more", "code_information": [ { "code": "80364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening oxycodone", "code_information": [ { "code": "80365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 329.50, "discounted_cash": 197.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxycodone level", "code_information": [ { "code": "80365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 329.50, "discounted_cash": 197.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening pregabalin", "code_information": [ { "code": "80366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 140.00, "discounted_cash": 84.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 140.00, "discounted_cash": 84.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening propoxyphene", "code_information": [ { "code": "80367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sedative hypnotics", "code_information": [ { "code": "80368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skel musc relaxant 3 or more", "code_information": [ { "code": "80370", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80370", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Stimulants synthetic", "code_information": [ { "code": "80371", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80371", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening tapentadol", "code_information": [ { "code": "80372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.52, "10th_percentile": 4.37, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.52, "10th_percentile": 4.37, "90th_percentile": 8.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.84, "10th_percentile": 8.84, "90th_percentile": 8.84, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screening tramadol", "code_information": [ { "code": "80373", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.46, "10th_percentile": 8.36, "90th_percentile": 8.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80373", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.46, "10th_percentile": 8.36, "90th_percentile": 8.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug/substance nos 1-3", "code_information": [ { "code": "80375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.75, "discounted_cash": 200.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug/substance nos 7/more", "code_information": [ { "code": "80377", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxassure comp 25 ur", "code_information": [ { "code": "80377", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis auto w/scope", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.25, "discounted_cash": 34.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 51.53, "10th_percentile": 43.28, "90th_percentile": 51.53, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 51.53, "10th_percentile": 43.28, "90th_percentile": 51.53, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "79", "median_amount": 17.75, "10th_percentile": 14.20, "90th_percentile": 17.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.57, "10th_percentile": 17.43, "90th_percentile": 17.71, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "243", "median_amount": 56.10, "10th_percentile": 44.44, "90th_percentile": 56.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 56.10, "10th_percentile": 48.29, "90th_percentile": 56.10, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "340", "median_amount": 16.84, "10th_percentile": 16.56, "90th_percentile": 17.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 17.39, "10th_percentile": 13.25, "90th_percentile": 17.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "241", "median_amount": 17.40, "10th_percentile": 16.57, "90th_percentile": 17.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 51.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 51.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 15.20, "10th_percentile": 12.97, "90th_percentile": 15.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "15", "median_amount": 52.74, "10th_percentile": 45.40, "90th_percentile": 53.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "15", "median_amount": 52.74, "10th_percentile": 45.40, "90th_percentile": 53.19, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Urinalysis routine", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.25, "discounted_cash": 34.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 51.53, "10th_percentile": 43.28, "90th_percentile": 51.53, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 51.53, "10th_percentile": 43.28, "90th_percentile": 51.53, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "79", "median_amount": 17.75, "10th_percentile": 14.20, "90th_percentile": 17.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.57, "10th_percentile": 17.43, "90th_percentile": 17.71, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "243", "median_amount": 56.10, "10th_percentile": 44.44, "90th_percentile": 56.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 56.10, "10th_percentile": 48.29, "90th_percentile": 56.10, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "340", "median_amount": 16.84, "10th_percentile": 16.56, "90th_percentile": 17.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 17.39, "10th_percentile": 13.25, "90th_percentile": 17.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "241", "median_amount": 17.40, "10th_percentile": 16.57, "90th_percentile": 17.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 51.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 50.21, "10th_percentile": 50.21, "90th_percentile": 51.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 15.20, "10th_percentile": 12.97, "90th_percentile": 15.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "15", "median_amount": 52.74, "10th_percentile": 45.40, "90th_percentile": 53.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "15", "median_amount": 52.74, "10th_percentile": 45.40, "90th_percentile": 53.19, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Urinalysis nonauto w/o scope", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62.75, "discounted_cash": 37.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 18.52, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.49, "10th_percentile": 61.49, "90th_percentile": 61.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 18.45, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis w/o microscopy", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62.75, "discounted_cash": 37.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 18.52, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.49, "10th_percentile": 61.49, "90th_percentile": 61.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 18.45, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis auto w/o scope", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62.75, "discounted_cash": 37.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.49, "10th_percentile": 2.79, "90th_percentile": 3.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.02, "10th_percentile": 9.50, "90th_percentile": 11.02, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 3.31, "10th_percentile": 3.31, "90th_percentile": 3.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.49, "10th_percentile": 3.49, "90th_percentile": 3.49, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.43, "10th_percentile": 3.43, "90th_percentile": 3.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis w/o microscopy", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62.75, "discounted_cash": 37.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.49, "10th_percentile": 2.79, "90th_percentile": 3.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.02, "10th_percentile": 9.50, "90th_percentile": 11.02, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 3.31, "10th_percentile": 3.31, "90th_percentile": 3.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.49, "10th_percentile": 3.49, "90th_percentile": 3.49, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.43, "10th_percentile": 3.43, "90th_percentile": 3.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Waived urine auto wo micro", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11.25, "discounted_cash": 6.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "QW", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 3.26, "10th_percentile": 2.61, "90th_percentile": 3.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.20, "10th_percentile": 3.20, "90th_percentile": 3.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "127", "median_amount": 8.23, "10th_percentile": 3.19, "90th_percentile": 11.02, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.02, "10th_percentile": 11.02, "90th_percentile": 11.02, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "113", "median_amount": 3.31, "10th_percentile": 3.19, "90th_percentile": 3.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.19, "10th_percentile": 3.19, "90th_percentile": 3.43, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "60", "median_amount": 3.43, "10th_percentile": 3.20, "90th_percentile": 3.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis", "code_information": [ { "code": "81005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine acetone semi-quanitative", "code_information": [ { "code": "81005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Microscopic exam of urine", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.71, "10th_percentile": 16.71, "90th_percentile": 16.71, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis microscopic", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.71, "10th_percentile": 16.71, "90th_percentile": 16.71, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine pregnancy test", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.75, "discounted_cash": 16.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.43, "10th_percentile": 8.43, "90th_percentile": 8.43, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Waived pregnancy urine test", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.75, "discounted_cash": 16.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "QW", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.43, "10th_percentile": 8.43, "90th_percentile": 8.43, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.98, "10th_percentile": 7.98, "90th_percentile": 7.98, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.43, "10th_percentile": 8.43, "90th_percentile": 8.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr-abl1 cml/all p", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1640.00, "discounted_cash": 984.00, "minimum": 162.32, "maximum": 475.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 475.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 475.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 162.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr/abl1 gene major bp", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1640.00, "discounted_cash": 984.00, "minimum": 162.32, "maximum": 475.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 475.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 475.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 162.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr-abl1 cml/all p", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 560.00, "discounted_cash": 336.00, "minimum": 143.39, "maximum": 420.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 420.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 420.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 143.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr/abl1 gene minor bp", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 560.00, "discounted_cash": 336.00, "minimum": 143.39, "maximum": 420.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 420.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 420.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 143.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hered hemochromatosis", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 654.00, "discounted_cash": 392.40, "minimum": 64.71, "maximum": 189.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 189.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 189.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 64.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hfe gene", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 654.00, "discounted_cash": 392.40, "minimum": 64.71, "maximum": 189.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 189.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 189.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 64.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mopath procedure level 4", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 740.00, "discounted_cash": 444.00, "minimum": 183.35, "maximum": 537.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 537.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 537.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 183.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Y chromosome microde", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 740.00, "discounted_cash": 444.00, "minimum": 183.35, "maximum": 537.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 537.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 537.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 183.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nfct ds bv&vaginitis dna alg", "code_information": [ { "code": "81514", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 828.50, "discounted_cash": 497.10, "minimum": 260.36, "maximum": 763.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 256.84, "10th_percentile": 256.84, "90th_percentile": 256.84, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 763.35, "count": "1 through 10", "median_amount": 622.02, "10th_percentile": 588.56, "90th_percentile": 655.47, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 763.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 243.58, "10th_percentile": 243.58, "90th_percentile": 243.58, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 260.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.70, "10th_percentile": 240.90, "90th_percentile": 250.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nfct ds vb/vaginitis dna alg", "code_information": [ { "code": "81514", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 828.50, "discounted_cash": 497.10, "minimum": 260.36, "maximum": 763.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 256.84, "10th_percentile": 256.84, "90th_percentile": 256.84, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 763.35, "count": "1 through 10", "median_amount": 622.02, "10th_percentile": 588.56, "90th_percentile": 655.47, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 763.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 243.58, "10th_percentile": 243.58, "90th_percentile": 243.58, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 260.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.70, "10th_percentile": 240.90, "90th_percentile": 250.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetone serum quantitative", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.27, "10th_percentile": 25.27, "90th_percentile": 25.27, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.87, "10th_percentile": 77.52, "90th_percentile": 79.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.76, "10th_percentile": 23.16, "90th_percentile": 23.96, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.76, "10th_percentile": 24.76, "90th_percentile": 24.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 24.77, "10th_percentile": 23.55, "90th_percentile": 24.77, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.26, "10th_percentile": 24.39, "90th_percentile": 42.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Test for acetone/ketones", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.27, "10th_percentile": 25.27, "90th_percentile": 25.27, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.87, "10th_percentile": 77.52, "90th_percentile": 79.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.76, "10th_percentile": 23.16, "90th_percentile": 23.96, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.76, "10th_percentile": 24.76, "90th_percentile": 24.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 24.77, "10th_percentile": 23.55, "90th_percentile": 24.77, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.26, "10th_percentile": 24.39, "90th_percentile": 42.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetone assay", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetone serum quantitative", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adrenocorticotropic hormone", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 693.50, "discounted_cash": 416.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 427.57, "10th_percentile": 427.57, "90th_percentile": 427.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 200.59, "10th_percentile": 200.59, "90th_percentile": 200.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 224.49, "10th_percentile": 224.49, "90th_percentile": 224.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 693.50, "discounted_cash": 416.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 427.57, "10th_percentile": 427.57, "90th_percentile": 427.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 200.59, "10th_percentile": 200.59, "90th_percentile": 200.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 224.49, "10th_percentile": 224.49, "90th_percentile": 224.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albumin", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89.25, "discounted_cash": 53.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 87.46, "10th_percentile": 83.30, "90th_percentile": 87.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 26.24, "10th_percentile": 25.82, "90th_percentile": 27.12, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.47, "10th_percentile": 25.95, "90th_percentile": 26.99, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.12, "10th_percentile": 26.09, "90th_percentile": 27.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of serum albumin", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89.25, "discounted_cash": 53.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 87.46, "10th_percentile": 83.30, "90th_percentile": 87.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 26.24, "10th_percentile": 25.82, "90th_percentile": 27.12, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.47, "10th_percentile": 25.95, "90th_percentile": 26.99, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.12, "10th_percentile": 26.09, "90th_percentile": 27.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ur albumin quantitative", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 93.60, "10th_percentile": 93.60, "90th_percentile": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 93.60, "10th_percentile": 93.60, "90th_percentile": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 32.24, "10th_percentile": 25.79, "90th_percentile": 32.24, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 101.92, "10th_percentile": 59.61, "90th_percentile": 101.92, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.65, "10th_percentile": 31.23, "90th_percentile": 74.36, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "108", "median_amount": 30.58, "10th_percentile": 30.08, "90th_percentile": 31.60, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 32.24, "10th_percentile": 30.54, "90th_percentile": 32.24, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 31.60, "10th_percentile": 30.08, "90th_percentile": 31.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 59.75, "10th_percentile": 34.58, "90th_percentile": 84.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 59.75, "10th_percentile": 34.58, "90th_percentile": 84.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 28.29, "10th_percentile": 24.75, "90th_percentile": 34.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.80, "10th_percentile": 95.80, "90th_percentile": 95.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.80, "10th_percentile": 95.80, "90th_percentile": 95.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Urine microalbumin", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 93.60, "10th_percentile": 93.60, "90th_percentile": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 93.60, "10th_percentile": 93.60, "90th_percentile": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 32.24, "10th_percentile": 25.79, "90th_percentile": 32.24, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 101.92, "10th_percentile": 59.61, "90th_percentile": 101.92, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.65, "10th_percentile": 31.23, "90th_percentile": 74.36, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "108", "median_amount": 30.58, "10th_percentile": 30.08, "90th_percentile": 31.60, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 32.24, "10th_percentile": 30.54, "90th_percentile": 32.24, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 31.60, "10th_percentile": 30.08, "90th_percentile": 31.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 59.75, "10th_percentile": 34.58, "90th_percentile": 84.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 59.75, "10th_percentile": 34.58, "90th_percentile": 84.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 28.29, "10th_percentile": 24.75, "90th_percentile": 34.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.80, "10th_percentile": 95.80, "90th_percentile": 95.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.80, "10th_percentile": 95.80, "90th_percentile": 95.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of breath ethanol", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 538.50, "discounted_cash": 323.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breathalyzer - alcohol", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 538.50, "discounted_cash": 323.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 174.75, "discounted_cash": 104.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.54, "10th_percentile": 47.54, "90th_percentile": 47.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 174.75, "discounted_cash": 104.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.54, "10th_percentile": 47.54, "90th_percentile": 47.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aldosterone serum", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 731.50, "discounted_cash": 438.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 546.06, "10th_percentile": 546.06, "90th_percentile": 546.06, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 204.77, "10th_percentile": 204.77, "90th_percentile": 204.77, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 216.93, "10th_percentile": 212.67, "90th_percentile": 221.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 731.50, "discounted_cash": 438.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 546.06, "10th_percentile": 546.06, "90th_percentile": 546.06, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 204.77, "10th_percentile": 204.77, "90th_percentile": 204.77, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 216.93, "10th_percentile": 212.67, "90th_percentile": 221.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alpha 1 antitrypsyn", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.25, "discounted_cash": 144.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.29, "10th_percentile": 73.29, "90th_percentile": 73.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.55, "10th_percentile": 69.80, "90th_percentile": 73.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alpha-1-antitrypsin total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.25, "discounted_cash": 144.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.29, "10th_percentile": 73.29, "90th_percentile": 73.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.55, "10th_percentile": 69.80, "90th_percentile": 73.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alpha fetoprotein", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 301.25, "discounted_cash": 180.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.11, "10th_percentile": 71.11, "90th_percentile": 71.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.53, "10th_percentile": 91.53, "90th_percentile": 91.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alpha-fetoprotein serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 301.25, "discounted_cash": 180.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.11, "10th_percentile": 71.11, "90th_percentile": 71.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.53, "10th_percentile": 91.53, "90th_percentile": 91.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Afp tetra afp-l3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1156.25, "discounted_cash": 693.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alpha-fetoprotein l3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1156.25, "discounted_cash": 693.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 261.75, "discounted_cash": 157.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.59, "10th_percentile": 69.45, "90th_percentile": 81.14, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.73, "10th_percentile": 75.73, "90th_percentile": 75.73, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 244.26, "10th_percentile": 172.28, "90th_percentile": 256.51, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.66, "10th_percentile": 236.99, "90th_percentile": 254.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 76.96, "10th_percentile": 75.72, "90th_percentile": 79.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.66, "10th_percentile": 61.49, "90th_percentile": 78.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 79.52, "10th_percentile": 75.73, "90th_percentile": 79.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 261.75, "discounted_cash": 157.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.59, "10th_percentile": 69.45, "90th_percentile": 81.14, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.73, "10th_percentile": 75.73, "90th_percentile": 75.73, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 244.26, "10th_percentile": 172.28, "90th_percentile": 256.51, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.66, "10th_percentile": 236.99, "90th_percentile": 254.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 76.96, "10th_percentile": 75.72, "90th_percentile": 79.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.66, "10th_percentile": 61.49, "90th_percentile": 78.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 79.52, "10th_percentile": 75.73, "90th_percentile": 79.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.95, "10th_percentile": 17.33, "90th_percentile": 33.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.41, "10th_percentile": 114.41, "90th_percentile": 114.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.33, "10th_percentile": 34.33, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.47, "10th_percentile": 34.95, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.19, "10th_percentile": 30.19, "90th_percentile": 30.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.95, "10th_percentile": 17.33, "90th_percentile": 33.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.41, "10th_percentile": 114.41, "90th_percentile": 114.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.33, "10th_percentile": 34.33, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.47, "10th_percentile": 34.95, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.19, "10th_percentile": 30.19, "90th_percentile": 30.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Angiotensin i enzyme test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.25, "discounted_cash": 157.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.67, "10th_percentile": 79.67, "90th_percentile": 79.67, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.30, "10th_percentile": 81.30, "90th_percentile": 81.30, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 75.88, "90th_percentile": 75.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Angiotension conversion enzyme", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.25, "discounted_cash": 157.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.67, "10th_percentile": 79.67, "90th_percentile": 79.67, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.30, "10th_percentile": 81.30, "90th_percentile": 81.30, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 75.88, "90th_percentile": 75.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apolipoprotein ea", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 378.75, "discounted_cash": 227.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.03, "10th_percentile": 12.81, "90th_percentile": 13.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of apolipoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 378.75, "discounted_cash": 227.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.03, "10th_percentile": 12.81, "90th_percentile": 13.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bilirubin total", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 90.50, "discounted_cash": 54.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.77, "10th_percentile": 30.77, "90th_percentile": 30.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bilirubin direct", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 90.50, "discounted_cash": 54.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.69, "10th_percentile": 88.69, "90th_percentile": 88.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 0.21, "10th_percentile": 0.21, "90th_percentile": 0.21, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.50, "10th_percentile": 27.50, "90th_percentile": 27.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.77, "10th_percentile": 30.77, "90th_percentile": 30.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of biotinidase", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 303.00, "discounted_cash": 181.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biotinidase", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 303.00, "discounted_cash": 181.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colopak per 1-3 screen", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.25, "discounted_cash": 47.55, "minimum": 4.34, "maximum": 12.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.47, "10th_percentile": 20.47, "90th_percentile": 20.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Occult blood feces", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.25, "discounted_cash": 47.55, "minimum": 4.34, "maximum": 12.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.47, "10th_percentile": 20.47, "90th_percentile": 20.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Waived colopak per 1-3 screen", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14.50, "discounted_cash": 8.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "QW", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Occult blood gastric 1-3", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.16, "10th_percentile": 29.16, "90th_percentile": 29.16, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Occult blood other sources", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.16, "10th_percentile": 29.16, "90th_percentile": 29.16, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colopak per 1-3 dx", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.25, "discounted_cash": 45.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.72, "10th_percentile": 74.72, "90th_percentile": 74.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.42, "10th_percentile": 22.11, "90th_percentile": 22.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.03, "10th_percentile": 22.03, "90th_percentile": 22.03, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.61, "10th_percentile": 22.15, "90th_percentile": 23.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.93, "10th_percentile": 25.93, "90th_percentile": 25.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Occult bld feces 1-3 tests", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.25, "discounted_cash": 45.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.72, "10th_percentile": 74.72, "90th_percentile": 74.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.42, "10th_percentile": 22.11, "90th_percentile": 22.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.03, "10th_percentile": 22.03, "90th_percentile": 22.03, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.61, "10th_percentile": 22.15, "90th_percentile": 23.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.93, "10th_percentile": 25.93, "90th_percentile": 25.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Waived colopak per 1-3 dx", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14.50, "discounted_cash": 8.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "QW", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcifediol 25 oh vit d 3", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.50, "discounted_cash": 318.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 409.86, "10th_percentile": 388.12, "90th_percentile": 446.29, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 409.86, "10th_percentile": 388.12, "90th_percentile": 446.29, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "46", "median_amount": 160.81, "10th_percentile": 125.49, "90th_percentile": 164.77, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 153.73, "10th_percentile": 153.73, "90th_percentile": 153.73, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "162", "median_amount": 274.47, "10th_percentile": 38.64, "90th_percentile": 518.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 257.90, "10th_percentile": 88.32, "90th_percentile": 430.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "187", "median_amount": 156.26, "10th_percentile": 151.74, "90th_percentile": 161.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 161.47, "10th_percentile": 153.72, "90th_percentile": 164.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 161.48, "10th_percentile": 153.73, "90th_percentile": 161.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 330.83, "10th_percentile": 203.80, "90th_percentile": 457.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 330.83, "10th_percentile": 203.80, "90th_percentile": 457.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 144.57, "10th_percentile": 113.08, "90th_percentile": 176.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 489.62, "10th_percentile": 470.83, "90th_percentile": 489.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 489.62, "10th_percentile": 470.83, "90th_percentile": 489.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vitamin d 25 hydroxy", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 531.50, "discounted_cash": 318.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 409.86, "10th_percentile": 388.12, "90th_percentile": 446.29, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 409.86, "10th_percentile": 388.12, "90th_percentile": 446.29, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "46", "median_amount": 160.81, "10th_percentile": 125.49, "90th_percentile": 164.77, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 153.73, "10th_percentile": 153.73, "90th_percentile": 153.73, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "162", "median_amount": 274.47, "10th_percentile": 38.64, "90th_percentile": 518.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 257.90, "10th_percentile": 88.32, "90th_percentile": 430.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "187", "median_amount": 156.26, "10th_percentile": 151.74, "90th_percentile": 161.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 161.47, "10th_percentile": 153.72, "90th_percentile": 164.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 161.48, "10th_percentile": 153.73, "90th_percentile": 161.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 330.83, "10th_percentile": 203.80, "90th_percentile": 457.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 330.83, "10th_percentile": 203.80, "90th_percentile": 457.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 144.57, "10th_percentile": 113.08, "90th_percentile": 176.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 489.62, "10th_percentile": 470.83, "90th_percentile": 489.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 489.62, "10th_percentile": 470.83, "90th_percentile": 489.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of calcitonin", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 481.25, "discounted_cash": 288.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.49, "10th_percentile": 141.49, "90th_percentile": 141.49, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcitonin serum", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 481.25, "discounted_cash": 288.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.49, "10th_percentile": 141.49, "90th_percentile": 141.49, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of calcium", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.75, "discounted_cash": 55.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.75, "10th_percentile": 27.64, "90th_percentile": 28.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.48, "10th_percentile": 70.95, "90th_percentile": 88.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.27, "10th_percentile": 26.47, "90th_percentile": 28.17, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.75, "discounted_cash": 55.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.75, "10th_percentile": 27.64, "90th_percentile": 28.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.48, "10th_percentile": 70.95, "90th_percentile": 88.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.27, "10th_percentile": 26.47, "90th_percentile": 28.17, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of calcium", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 245.75, "discounted_cash": 147.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 191.59, "10th_percentile": 185.09, "90th_percentile": 198.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.09, "10th_percentile": 71.09, "90th_percentile": 71.09, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 245.75, "discounted_cash": 147.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 191.59, "10th_percentile": 185.09, "90th_percentile": 198.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.09, "10th_percentile": 71.09, "90th_percentile": 71.09, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of calcium in urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.50, "discounted_cash": 65.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.37, "10th_percentile": 31.37, "90th_percentile": 31.37, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.97, "10th_percentile": 32.97, "90th_percentile": 32.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.50, "discounted_cash": 65.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.37, "10th_percentile": 31.37, "90th_percentile": 31.37, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.97, "10th_percentile": 32.97, "90th_percentile": 32.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calculus quantitative infrared", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.75, "discounted_cash": 139.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 198.09, "10th_percentile": 198.09, "90th_percentile": 198.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.99, "10th_percentile": 66.99, "90th_percentile": 66.99, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.16, "10th_percentile": 55.16, "90th_percentile": 55.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calculus spectroscopy", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.75, "discounted_cash": 139.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 198.09, "10th_percentile": 198.09, "90th_percentile": 198.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.99, "10th_percentile": 66.99, "90th_percentile": 66.99, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.16, "10th_percentile": 55.16, "90th_percentile": 55.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay blood carbon dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.75, "discounted_cash": 52.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Co2", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.75, "discounted_cash": 52.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay carboxyhb quant", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 221.75, "discounted_cash": 133.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 217.31, "10th_percentile": 217.31, "90th_percentile": 217.31, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.20, "10th_percentile": 65.20, "90th_percentile": 65.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.37, "10th_percentile": 67.37, "90th_percentile": 67.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carbon monoxide quan venous", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 221.75, "discounted_cash": 133.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 217.31, "10th_percentile": 217.31, "90th_percentile": 217.31, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.20, "10th_percentile": 65.20, "90th_percentile": 65.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.37, "10th_percentile": 67.37, "90th_percentile": 67.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C e a", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 340.50, "discounted_cash": 204.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carcinoembryonic antigen", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 340.50, "discounted_cash": 204.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 67.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carotene beta", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 67.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay three catecholamines", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 453.50, "discounted_cash": 272.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Catecholamines fractionated", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 453.50, "discounted_cash": 272.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.63, "10th_percentile": 58.63, "90th_percentile": 58.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.83, "10th_percentile": 55.83, "90th_percentile": 55.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.50, "10th_percentile": 52.50, "90th_percentile": 52.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.63, "10th_percentile": 58.63, "90th_percentile": 58.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.83, "10th_percentile": 55.83, "90th_percentile": 55.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.50, "10th_percentile": 52.50, "90th_percentile": 52.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of blood chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.75, "discounted_cash": 49.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.76, "10th_percentile": 12.76, "90th_percentile": 12.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chloride blood", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.75, "discounted_cash": 49.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.76, "10th_percentile": 12.76, "90th_percentile": 12.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.50, "discounted_cash": 62.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.50, "discounted_cash": 62.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay bld/serum cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.50, "discounted_cash": 47.10, "minimum": 4.31, "maximum": 12.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.63, "count": "1 through 10", "median_amount": 35.31, "10th_percentile": 35.31, "90th_percentile": 35.31, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.76, "10th_percentile": 12.76, "90th_percentile": 12.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cholesterol blood", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.50, "discounted_cash": 47.10, "minimum": 4.31, "maximum": 12.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.63, "count": "1 through 10", "median_amount": 35.31, "10th_percentile": 35.31, "90th_percentile": 35.31, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.76, "10th_percentile": 12.76, "90th_percentile": 12.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.25, "discounted_cash": 299.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.25, "discounted_cash": 299.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C-teleopeptide", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 335.50, "discounted_cash": 201.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.07, "10th_percentile": 114.07, "90th_percentile": 114.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collagen crosslinks", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 335.50, "discounted_cash": 201.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.07, "10th_percentile": 114.07, "90th_percentile": 114.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1020.50, "discounted_cash": 612.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 310.03, "10th_percentile": 310.03, "90th_percentile": 310.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 316.36, "10th_percentile": 316.36, "90th_percentile": 316.36, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Copper level", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1020.50, "discounted_cash": 612.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 310.03, "10th_percentile": 310.03, "90th_percentile": 310.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 316.36, "10th_percentile": 316.36, "90th_percentile": 316.36, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cortisol free", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.25, "discounted_cash": 180.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cortisol urinary free", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.25, "discounted_cash": 180.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cortisol total", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 293.00, "discounted_cash": 175.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.49, "10th_percentile": 86.49, "90th_percentile": 86.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 243.75, "10th_percentile": 65.38, "90th_percentile": 273.42, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.45, "10th_percentile": 84.76, "90th_percentile": 86.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.02, "10th_percentile": 85.62, "90th_percentile": 89.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.28, "10th_percentile": 81.22, "90th_percentile": 93.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total cortisol", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 293.00, "discounted_cash": 175.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.49, "10th_percentile": 86.49, "90th_percentile": 86.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 243.75, "10th_percentile": 65.38, "90th_percentile": 273.42, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.45, "10th_percentile": 84.76, "90th_percentile": 86.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.02, "10th_percentile": 85.62, "90th_percentile": 89.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.28, "10th_percentile": 81.22, "90th_percentile": 93.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Col chromotography qual/quan", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 432.75, "discounted_cash": 259.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.23, "10th_percentile": 123.15, "90th_percentile": 131.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 424.09, "10th_percentile": 424.09, "90th_percentile": 424.09, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug scrn quan levetiracetam", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 432.75, "discounted_cash": 259.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.23, "10th_percentile": 123.15, "90th_percentile": 131.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 424.09, "10th_percentile": 424.09, "90th_percentile": 424.09, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ck (cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.25, "discounted_cash": 70.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 37.38, "10th_percentile": 37.38, "90th_percentile": 37.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 37.38, "10th_percentile": 37.38, "90th_percentile": 37.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.46, "10th_percentile": 19.77, "90th_percentile": 36.35, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 114.90, "10th_percentile": 109.27, "90th_percentile": 114.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.09, "10th_percentile": 109.83, "90th_percentile": 114.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 34.48, "10th_percentile": 32.78, "90th_percentile": 34.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.98, "10th_percentile": 35.69, "90th_percentile": 36.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 35.63, "10th_percentile": 33.88, "90th_percentile": 35.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.11, "10th_percentile": 26.34, "90th_percentile": 31.90, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.63, "10th_percentile": 35.63, "90th_percentile": 35.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.63, "10th_percentile": 35.63, "90th_percentile": 35.63, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C k", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.25, "discounted_cash": 70.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 37.38, "10th_percentile": 37.38, "90th_percentile": 37.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 37.38, "10th_percentile": 37.38, "90th_percentile": 37.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.46, "10th_percentile": 19.77, "90th_percentile": 36.35, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 114.90, "10th_percentile": 109.27, "90th_percentile": 114.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.09, "10th_percentile": 109.83, "90th_percentile": 114.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 34.48, "10th_percentile": 32.78, "90th_percentile": 34.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.98, "10th_percentile": 35.69, "90th_percentile": 36.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 35.63, "10th_percentile": 33.88, "90th_percentile": 35.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.11, "10th_percentile": 26.34, "90th_percentile": 31.90, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.63, "10th_percentile": 35.63, "90th_percentile": 35.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.63, "10th_percentile": 35.63, "90th_percentile": 35.63, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C k m b", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Creatine mb fraction", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.25, "discounted_cash": 55.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.60, "10th_percentile": 28.32, "90th_percentile": 28.60, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 85.99, "10th_percentile": 40.99, "90th_percentile": 90.40, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.44, "10th_percentile": 34.66, "90th_percentile": 84.21, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 27.13, "10th_percentile": 26.66, "90th_percentile": 28.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.32, "10th_percentile": 26.66, "90th_percentile": 28.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.03, "10th_percentile": 26.66, "90th_percentile": 28.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.10, "10th_percentile": 21.73, "90th_percentile": 30.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Creatinine blood", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.25, "discounted_cash": 55.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.60, "10th_percentile": 28.32, "90th_percentile": 28.60, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 85.99, "10th_percentile": 40.99, "90th_percentile": 90.40, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.44, "10th_percentile": 34.66, "90th_percentile": 84.21, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 27.13, "10th_percentile": 26.66, "90th_percentile": 28.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.32, "10th_percentile": 26.66, "90th_percentile": 28.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.03, "10th_percentile": 26.66, "90th_percentile": 28.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.10, "10th_percentile": 21.73, "90th_percentile": 30.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24 hour urine creatinine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.54, "10th_percentile": 87.41, "90th_percentile": 157.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.54, "10th_percentile": 87.41, "90th_percentile": 157.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 28.91, "10th_percentile": 24.44, "90th_percentile": 57.82, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 86.97, "10th_percentile": 13.24, "90th_percentile": 177.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.58, "10th_percentile": 69.58, "90th_percentile": 69.58, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "136", "median_amount": 28.33, "10th_percentile": 26.96, "90th_percentile": 56.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 57.24, "10th_percentile": 26.96, "90th_percentile": 57.82, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "71", "median_amount": 28.34, "10th_percentile": 26.96, "90th_percentile": 56.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.76, "10th_percentile": 36.65, "90th_percentile": 81.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.76, "10th_percentile": 36.65, "90th_percentile": 81.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 25.37, "10th_percentile": 22.20, "90th_percentile": 54.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 128.85, "10th_percentile": 94.49, "90th_percentile": 163.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 128.85, "10th_percentile": 94.49, "90th_percentile": 163.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of urine creatinine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.54, "10th_percentile": 87.41, "90th_percentile": 157.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.54, "10th_percentile": 87.41, "90th_percentile": 157.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 28.91, "10th_percentile": 24.44, "90th_percentile": 57.82, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 86.97, "10th_percentile": 13.24, "90th_percentile": 177.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.58, "10th_percentile": 69.58, "90th_percentile": 69.58, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "136", "median_amount": 28.33, "10th_percentile": 26.96, "90th_percentile": 56.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 57.24, "10th_percentile": 26.96, "90th_percentile": 57.82, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "71", "median_amount": 28.34, "10th_percentile": 26.96, "90th_percentile": 56.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.76, "10th_percentile": 36.65, "90th_percentile": 81.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.76, "10th_percentile": 36.65, "90th_percentile": 81.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 25.37, "10th_percentile": 22.20, "90th_percentile": 54.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 128.85, "10th_percentile": 94.49, "90th_percentile": 163.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 128.85, "10th_percentile": 94.49, "90th_percentile": 163.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Creatinine clearance", "code_information": [ { "code": "82575", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.70, "10th_percentile": 52.70, "90th_percentile": 52.70, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.13, "10th_percentile": 63.15, "90th_percentile": 155.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.65, "10th_percentile": 50.48, "90th_percentile": 51.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.65, "10th_percentile": 51.65, "90th_percentile": 51.65, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.65, "10th_percentile": 51.65, "90th_percentile": 51.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.24, "10th_percentile": 46.24, "90th_percentile": 46.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Creatinine clearance test", "code_information": [ { "code": "82575", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.70, "10th_percentile": 52.70, "90th_percentile": 52.70, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.13, "10th_percentile": 63.15, "90th_percentile": 155.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.65, "10th_percentile": 50.48, "90th_percentile": 51.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.65, "10th_percentile": 51.65, "90th_percentile": 51.65, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.65, "10th_percentile": 51.65, "90th_percentile": 51.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.24, "10th_percentile": 46.24, "90th_percentile": 46.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of cryoglobulin", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cryoglobulin ql se", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "B12 assay", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 162.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 219.51, "10th_percentile": 200.66, "90th_percentile": 239.22, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 219.51, "10th_percentile": 200.66, "90th_percentile": 239.22, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 79.98, "10th_percentile": 63.98, "90th_percentile": 84.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.33, "10th_percentile": 82.33, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 182.63, "10th_percentile": 26.91, "90th_percentile": 265.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.52, "10th_percentile": 180.82, "90th_percentile": 251.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "137", "median_amount": 79.67, "10th_percentile": 78.38, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 84.01, "10th_percentile": 78.38, "90th_percentile": 84.01, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "85", "median_amount": 82.33, "10th_percentile": 78.39, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 195.97, "10th_percentile": 80.72, "90th_percentile": 249.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 195.97, "10th_percentile": 80.72, "90th_percentile": 249.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 73.71, "10th_percentile": 61.40, "90th_percentile": 87.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 237.67, "10th_percentile": 78.39, "90th_percentile": 249.65, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 237.67, "10th_percentile": 78.39, "90th_percentile": 249.65, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vitamin b-12", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 162.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 219.51, "10th_percentile": 200.66, "90th_percentile": 239.22, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 219.51, "10th_percentile": 200.66, "90th_percentile": 239.22, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 79.98, "10th_percentile": 63.98, "90th_percentile": 84.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.33, "10th_percentile": 82.33, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 182.63, "10th_percentile": 26.91, "90th_percentile": 265.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.52, "10th_percentile": 180.82, "90th_percentile": 251.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "137", "median_amount": 79.67, "10th_percentile": 78.38, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 84.01, "10th_percentile": 78.38, "90th_percentile": 84.01, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "85", "median_amount": 82.33, "10th_percentile": 78.39, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 195.97, "10th_percentile": 80.72, "90th_percentile": 249.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 195.97, "10th_percentile": 80.72, "90th_percentile": 249.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 73.71, "10th_percentile": 61.40, "90th_percentile": 87.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 237.67, "10th_percentile": 78.39, "90th_percentile": 249.65, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 237.67, "10th_percentile": 78.39, "90th_percentile": 249.65, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Test for urine cystines", "code_information": [ { "code": "82615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 171.75, "discounted_cash": 103.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine cystine qualitative", "code_information": [ { "code": "82615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 171.75, "discounted_cash": 103.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dehydroepiandrosterone", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 454.00, "discounted_cash": 272.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.48, "10th_percentile": 133.48, "90th_percentile": 133.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dehydroepiandrosterone (dhea)", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 454.00, "discounted_cash": 272.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.48, "10th_percentile": 133.48, "90th_percentile": 133.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dehydroepiandrosterone", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 399.50, "discounted_cash": 239.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 95.08, "10th_percentile": 95.08, "90th_percentile": 95.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dehydroepiandrosterone (s04)", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 399.50, "discounted_cash": 239.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 95.08, "10th_percentile": 95.08, "90th_percentile": 95.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dihydrotestosterone", "code_information": [ { "code": "82642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 98.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dihydroxyvitamin d 125", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 691.25, "discounted_cash": 414.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 209.18, "10th_percentile": 204.06, "90th_percentile": 214.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 162.10, "10th_percentile": 11.80, "90th_percentile": 337.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 319.88, "10th_percentile": 319.88, "90th_percentile": 319.88, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 203.23, "10th_percentile": 203.23, "90th_percentile": 208.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 210.01, "10th_percentile": 202.99, "90th_percentile": 210.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 188.02, "10th_percentile": 188.02, "90th_percentile": 188.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 188.02, "10th_percentile": 188.02, "90th_percentile": 188.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.52, "10th_percentile": 164.52, "90th_percentile": 164.52, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vit d 1 25-dihydroxy", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 691.25, "discounted_cash": 414.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 209.18, "10th_percentile": 204.06, "90th_percentile": 214.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 162.10, "10th_percentile": 11.80, "90th_percentile": 337.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 319.88, "10th_percentile": 319.88, "90th_percentile": 319.88, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 203.23, "10th_percentile": 203.23, "90th_percentile": 208.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 210.01, "10th_percentile": 202.99, "90th_percentile": 210.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 188.02, "10th_percentile": 188.02, "90th_percentile": 188.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 188.02, "10th_percentile": 188.02, "90th_percentile": 188.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.52, "10th_percentile": 164.52, "90th_percentile": 164.52, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 337.75, "discounted_cash": 202.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 197.59, "10th_percentile": 143.83, "90th_percentile": 251.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.30, "10th_percentile": 99.30, "90th_percentile": 99.30, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.61, "10th_percentile": 102.61, "90th_percentile": 102.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Erythropoietin level", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 337.75, "discounted_cash": 202.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 197.59, "10th_percentile": 143.83, "90th_percentile": 251.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.30, "10th_percentile": 99.30, "90th_percentile": 99.30, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.61, "10th_percentile": 102.61, "90th_percentile": 102.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of estradiol", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 501.50, "discounted_cash": 300.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 155.47, "10th_percentile": 155.47, "90th_percentile": 155.47, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.41, "10th_percentile": 15.41, "90th_percentile": 15.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 147.44, "10th_percentile": 145.54, "90th_percentile": 147.44, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 152.37, "10th_percentile": 152.37, "90th_percentile": 152.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.36, "10th_percentile": 119.36, "90th_percentile": 119.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Estradiol total", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 501.50, "discounted_cash": 300.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 155.47, "10th_percentile": 155.47, "90th_percentile": 155.47, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.41, "10th_percentile": 15.41, "90th_percentile": 15.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 147.44, "10th_percentile": 145.54, "90th_percentile": 147.44, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 152.37, "10th_percentile": 152.37, "90th_percentile": 152.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.36, "10th_percentile": 119.36, "90th_percentile": 119.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of estrogens", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 580.00, "discounted_cash": 348.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Estrogens fractionated", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 580.00, "discounted_cash": 348.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 389.75, "discounted_cash": 233.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.59, "10th_percentile": 114.59, "90th_percentile": 114.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 132.52, "10th_percentile": 132.52, "90th_percentile": 132.52, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Estrogens total", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 389.75, "discounted_cash": 233.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.59, "10th_percentile": 114.59, "90th_percentile": 114.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 132.52, "10th_percentile": 132.52, "90th_percentile": 132.52, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fats/lipids feces qual", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.75, "discounted_cash": 55.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fecal fat qualitative", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.75, "discounted_cash": 55.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of fecal fat", "code_information": [ { "code": "82715", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 412.50, "discounted_cash": 247.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.31, "10th_percentile": 119.31, "90th_percentile": 119.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fat differential feces quan", "code_information": [ { "code": "82715", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 412.50, "discounted_cash": 247.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.31, "10th_percentile": 119.31, "90th_percentile": 119.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 245.00, "discounted_cash": 147.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 220.50, "10th_percentile": 220.50, "90th_percentile": 220.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 220.50, "10th_percentile": 220.50, "90th_percentile": 220.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 74.13, "10th_percentile": 60.76, "90th_percentile": 75.95, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 54.65, "10th_percentile": 15.62, "90th_percentile": 228.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 234.34, "10th_percentile": 229.73, "90th_percentile": 238.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "76", "median_amount": 72.03, "10th_percentile": 70.86, "90th_percentile": 74.43, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.43, "10th_percentile": 70.86, "90th_percentile": 75.95, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 74.44, "10th_percentile": 70.87, "90th_percentile": 74.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 225.69, "10th_percentile": 225.69, "90th_percentile": 225.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 225.69, "10th_percentile": 225.69, "90th_percentile": 225.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 66.64, "10th_percentile": 60.88, "90th_percentile": 81.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 214.87, "10th_percentile": 99.67, "90th_percentile": 223.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 214.87, "10th_percentile": 99.67, "90th_percentile": 223.53, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 245.00, "discounted_cash": 147.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 220.50, "10th_percentile": 220.50, "90th_percentile": 220.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 220.50, "10th_percentile": 220.50, "90th_percentile": 220.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 74.13, "10th_percentile": 60.76, "90th_percentile": 75.95, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 54.65, "10th_percentile": 15.62, "90th_percentile": 228.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 234.34, "10th_percentile": 229.73, "90th_percentile": 238.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "76", "median_amount": 72.03, "10th_percentile": 70.86, "90th_percentile": 74.43, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.43, "10th_percentile": 70.86, "90th_percentile": 75.95, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 74.44, "10th_percentile": 70.87, "90th_percentile": 74.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 225.69, "10th_percentile": 225.69, "90th_percentile": 225.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 225.69, "10th_percentile": 225.69, "90th_percentile": 225.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 66.64, "10th_percentile": 60.88, "90th_percentile": 81.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 214.87, "10th_percentile": 99.67, "90th_percentile": 223.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 214.87, "10th_percentile": 99.67, "90th_percentile": 223.53, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of fetal fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1156.25, "discounted_cash": 693.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fetal fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1156.25, "discounted_cash": 693.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of folic acid serum", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.00, "discounted_cash": 158.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 237.60, "10th_percentile": 237.60, "90th_percentile": 237.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 237.60, "10th_percentile": 237.60, "90th_percentile": 237.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.84, "10th_percentile": 68.17, "90th_percentile": 81.84, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.22, "10th_percentile": 216.68, "90th_percentile": 258.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.22, "10th_percentile": 246.22, "90th_percentile": 246.22, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 77.62, "10th_percentile": 76.33, "90th_percentile": 80.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.02, "10th_percentile": 80.36, "90th_percentile": 81.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 76.34, "10th_percentile": 76.34, "90th_percentile": 80.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 71.81, "10th_percentile": 71.81, "90th_percentile": 71.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 71.81, "10th_percentile": 71.81, "90th_percentile": 71.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.08, "10th_percentile": 48.30, "90th_percentile": 89.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.88, "10th_percentile": 199.42, "90th_percentile": 238.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.88, "10th_percentile": 199.42, "90th_percentile": 238.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Folic acid; serum", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.00, "discounted_cash": 158.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 237.60, "10th_percentile": 237.60, "90th_percentile": 237.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 237.60, "10th_percentile": 237.60, "90th_percentile": 237.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.84, "10th_percentile": 68.17, "90th_percentile": 81.84, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.22, "10th_percentile": 216.68, "90th_percentile": 258.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 246.22, "10th_percentile": 246.22, "90th_percentile": 246.22, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 77.62, "10th_percentile": 76.33, "90th_percentile": 80.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.02, "10th_percentile": 80.36, "90th_percentile": 81.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 76.34, "10th_percentile": 76.34, "90th_percentile": 80.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 71.81, "10th_percentile": 71.81, "90th_percentile": 71.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 71.81, "10th_percentile": 71.81, "90th_percentile": 71.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.08, "10th_percentile": 48.30, "90th_percentile": 89.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.88, "10th_percentile": 199.42, "90th_percentile": 238.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.88, "10th_percentile": 199.42, "90th_percentile": 238.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Galactose", "code_information": [ { "code": "82776", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 211.25, "discounted_cash": 126.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Galactose transferase test", "code_information": [ { "code": "82776", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 211.25, "discounted_cash": 126.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aca iga", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 167.25, "discounted_cash": 100.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.85, "10th_percentile": 51.85, "90th_percentile": 51.85, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.84, "10th_percentile": 55.82, "90th_percentile": 95.85, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.17, "10th_percentile": 9.17, "90th_percentile": 9.17, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 50.81, "10th_percentile": 48.46, "90th_percentile": 145.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 152.43, "10th_percentile": 49.36, "90th_percentile": 152.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.50, "10th_percentile": 43.14, "90th_percentile": 45.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay iga/igd/igg/igm each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 167.25, "discounted_cash": 100.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.85, "10th_percentile": 51.85, "90th_percentile": 51.85, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.84, "10th_percentile": 55.82, "90th_percentile": 95.85, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.17, "10th_percentile": 9.17, "90th_percentile": 9.17, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 50.81, "10th_percentile": 48.46, "90th_percentile": 145.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 152.43, "10th_percentile": 49.36, "90th_percentile": 152.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.50, "10th_percentile": 43.14, "90th_percentile": 45.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 295.75, "discounted_cash": 177.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.82, "10th_percentile": 69.82, "90th_percentile": 69.82, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 282.85, "10th_percentile": 277.27, "90th_percentile": 288.43, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.52, "10th_percentile": 85.52, "90th_percentile": 86.53, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.68, "10th_percentile": 91.68, "90th_percentile": 91.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.69, "10th_percentile": 50.23, "90th_percentile": 89.85, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.56, "10th_percentile": 100.56, "90th_percentile": 100.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I g e quantitative", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 295.75, "discounted_cash": 177.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.82, "10th_percentile": 69.82, "90th_percentile": 69.82, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 282.85, "10th_percentile": 277.27, "90th_percentile": 288.43, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.52, "10th_percentile": 85.52, "90th_percentile": 86.53, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.68, "10th_percentile": 91.68, "90th_percentile": 91.68, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.69, "10th_percentile": 50.23, "90th_percentile": 89.85, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.56, "10th_percentile": 100.56, "90th_percentile": 100.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ig g subclasses", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.50, "discounted_cash": 86.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.78, "10th_percentile": 41.78, "90th_percentile": 41.78, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Igg 1 2 3 or 4 each", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.50, "discounted_cash": 86.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.78, "10th_percentile": 41.78, "90th_percentile": 41.78, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood ph", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.75, "discounted_cash": 118.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.30, "10th_percentile": 58.95, "90th_percentile": 110.35, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 193.79, "10th_percentile": 189.13, "90th_percentile": 193.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 58.14, "10th_percentile": 57.19, "90th_percentile": 58.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.07, "10th_percentile": 57.77, "90th_percentile": 61.05, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 60.08, "10th_percentile": 57.20, "90th_percentile": 60.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 145.74, "10th_percentile": 145.74, "90th_percentile": 145.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 145.74, "10th_percentile": 145.74, "90th_percentile": 145.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.52, "10th_percentile": 53.79, "90th_percentile": 67.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venous ph", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.75, "discounted_cash": 118.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.30, "10th_percentile": 58.95, "90th_percentile": 110.35, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 193.79, "10th_percentile": 189.13, "90th_percentile": 193.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 58.14, "10th_percentile": 57.19, "90th_percentile": 58.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.07, "10th_percentile": 57.77, "90th_percentile": 61.05, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 60.08, "10th_percentile": 57.20, "90th_percentile": 60.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 145.74, "10th_percentile": 145.74, "90th_percentile": 145.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 145.74, "10th_percentile": 145.74, "90th_percentile": 145.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.52, "10th_percentile": 53.79, "90th_percentile": 67.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abg 02 sat w direct measure", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 182.75, "discounted_cash": 109.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 56.65, "10th_percentile": 56.65, "90th_percentile": 56.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 56.65, "10th_percentile": 56.65, "90th_percentile": 56.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 56.65, "10th_percentile": 53.94, "90th_percentile": 97.63, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 179.09, "10th_percentile": 170.52, "90th_percentile": 382.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 170.52, "10th_percentile": 170.52, "90th_percentile": 177.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 53.73, "10th_percentile": 52.86, "90th_percentile": 105.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.09, "10th_percentile": 47.74, "90th_percentile": 56.65, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 55.52, "10th_percentile": 52.87, "90th_percentile": 111.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.04, "10th_percentile": 95.14, "90th_percentile": 98.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood gases w/o2 saturation", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 182.75, "discounted_cash": 109.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 56.65, "10th_percentile": 56.65, "90th_percentile": 56.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 56.65, "10th_percentile": 56.65, "90th_percentile": 56.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 56.65, "10th_percentile": 53.94, "90th_percentile": 97.63, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 179.09, "10th_percentile": 170.52, "90th_percentile": 382.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 170.52, "10th_percentile": 170.52, "90th_percentile": 177.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 53.73, "10th_percentile": 52.86, "90th_percentile": 105.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.09, "10th_percentile": 47.74, "90th_percentile": 56.65, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 55.52, "10th_percentile": 52.87, "90th_percentile": 111.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.04, "10th_percentile": 95.14, "90th_percentile": 98.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 316.75, "discounted_cash": 190.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 316.75, "discounted_cash": 190.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose body fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.75, "discounted_cash": 42.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.50, "10th_percentile": 21.50, "90th_percentile": 21.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose other fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.75, "discounted_cash": 42.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.50, "10th_percentile": 21.50, "90th_percentile": 21.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay glucose blood quant", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.75, "discounted_cash": 42.45, "minimum": 3.89, "maximum": 11.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.85, "10th_percentile": 20.85, "90th_percentile": 20.85, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 11.41, "count": "1 through 10", "median_amount": 58.86, "10th_percentile": 55.67, "90th_percentile": 59.53, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 11.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1.00, "10th_percentile": 1.00, "90th_percentile": 1.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.43, "10th_percentile": 20.43, "90th_percentile": 20.43, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.50, "10th_percentile": 21.50, "90th_percentile": 38.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose (fbs)", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.75, "discounted_cash": 42.45, "minimum": 3.89, "maximum": 11.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.85, "10th_percentile": 20.85, "90th_percentile": 20.85, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 11.41, "count": "1 through 10", "median_amount": 58.86, "10th_percentile": 55.67, "90th_percentile": 59.53, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 11.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1.00, "10th_percentile": 1.00, "90th_percentile": 1.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.43, "10th_percentile": 20.43, "90th_percentile": 20.43, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.50, "10th_percentile": 21.50, "90th_percentile": 38.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose blood reagent strip", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 54.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "59", "median_amount": 56.42, "10th_percentile": 25.97, "90th_percentile": 112.84, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "109", "median_amount": 89.18, "10th_percentile": 84.77, "90th_percentile": 356.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.18, "10th_percentile": 86.09, "90th_percentile": 214.03, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "127", "median_amount": 27.65, "10th_percentile": 26.28, "90th_percentile": 107.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 55.29, "10th_percentile": 21.03, "90th_percentile": 105.66, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "103", "median_amount": 27.65, "10th_percentile": 26.29, "90th_percentile": 105.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 29.41, "10th_percentile": 22.41, "90th_percentile": 90.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reagent strip/blood glucose", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 54.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "59", "median_amount": 56.42, "10th_percentile": 25.97, "90th_percentile": 112.84, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "109", "median_amount": 89.18, "10th_percentile": 84.77, "90th_percentile": 356.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.18, "10th_percentile": 86.09, "90th_percentile": 214.03, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "127", "median_amount": 27.65, "10th_percentile": 26.28, "90th_percentile": 107.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 55.29, "10th_percentile": 21.03, "90th_percentile": 105.66, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "103", "median_amount": 27.65, "10th_percentile": 26.29, "90th_percentile": 105.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 29.41, "10th_percentile": 22.41, "90th_percentile": 90.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Waived glucose blood reagent", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "QW", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.34, "10th_percentile": 4.34, "90th_percentile": 4.34, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.14, "10th_percentile": 4.05, "90th_percentile": 4.23, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.03, "10th_percentile": 4.03, "90th_percentile": 4.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose tolerance 3hr", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.00, "discounted_cash": 138.60, "minimum": 12.74, "maximum": 37.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.36, "count": "1 through 10", "median_amount": 179.79, "10th_percentile": 168.13, "90th_percentile": 191.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.84, "10th_percentile": 66.84, "90th_percentile": 66.84, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose tolerance test (gtt)", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.00, "discounted_cash": 138.60, "minimum": 12.74, "maximum": 37.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.36, "count": "1 through 10", "median_amount": 179.79, "10th_percentile": 168.13, "90th_percentile": 191.45, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.84, "10th_percentile": 66.84, "90th_percentile": 66.84, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose tolerance each add spe", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.75, "discounted_cash": 42.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gtt-added samples", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.75, "discounted_cash": 42.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of g6pd enzyme", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 61.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Q6pd qn bld and red", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 61.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.50, "discounted_cash": 77.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.45, "10th_percentile": 24.24, "90th_percentile": 39.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glutamyltransferasegamma ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.50, "discounted_cash": 77.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 6.38, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.45, "10th_percentile": 24.24, "90th_percentile": 39.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of gonadotropin (fsh)", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.46, "10th_percentile": 103.46, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 327.07, "10th_percentile": 327.07, "90th_percentile": 327.07, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.96, "10th_percentile": 97.02, "90th_percentile": 100.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.46, "10th_percentile": 82.84, "90th_percentile": 110.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fsh (serum)", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.46, "10th_percentile": 103.46, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 327.07, "10th_percentile": 327.07, "90th_percentile": 327.07, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.96, "10th_percentile": 97.02, "90th_percentile": 100.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.46, "10th_percentile": 82.84, "90th_percentile": 110.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of gonadotropin (lh)", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 332.75, "discounted_cash": 199.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.15, "10th_percentile": 103.15, "90th_percentile": 103.15, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 326.09, "10th_percentile": 326.09, "90th_percentile": 326.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.66, "10th_percentile": 96.72, "90th_percentile": 100.60, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.09, "10th_percentile": 101.09, "90th_percentile": 101.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.17, "10th_percentile": 82.59, "90th_percentile": 109.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lutenizing hormone", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 332.75, "discounted_cash": 199.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.15, "10th_percentile": 103.15, "90th_percentile": 103.15, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 326.09, "10th_percentile": 326.09, "90th_percentile": 326.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.66, "10th_percentile": 96.72, "90th_percentile": 100.60, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.09, "10th_percentile": 101.09, "90th_percentile": 101.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.17, "10th_percentile": 82.59, "90th_percentile": 109.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay growth hormone (hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 299.75, "discounted_cash": 179.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.07, "10th_percentile": 91.07, "90th_percentile": 91.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Growth hormone serum", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 299.75, "discounted_cash": 179.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.07, "10th_percentile": 91.07, "90th_percentile": 91.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of haptoglobin quant", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 225.75, "discounted_cash": 135.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haptoglobin quanitative", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 225.75, "discounted_cash": 135.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clo test - h pylori", "code_information": [ { "code": "83013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1209.25, "discounted_cash": 725.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 657.71, "10th_percentile": 238.28, "90th_percentile": 1074.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 355.52, "10th_percentile": 343.06, "90th_percentile": 355.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 358.61, "10th_percentile": 349.84, "90th_percentile": 367.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1060.76, "10th_percentile": 1060.76, "90th_percentile": 1060.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1060.76, "10th_percentile": 1060.76, "90th_percentile": 1060.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 321.06, "10th_percentile": 206.05, "90th_percentile": 328.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "H pylori (c-13) breath", "code_information": [ { "code": "83013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1209.25, "discounted_cash": 725.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 657.71, "10th_percentile": 238.28, "90th_percentile": 1074.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 355.52, "10th_percentile": 343.06, "90th_percentile": 355.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 358.61, "10th_percentile": 349.84, "90th_percentile": 367.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1060.76, "10th_percentile": 1060.76, "90th_percentile": 1060.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1060.76, "10th_percentile": 1060.76, "90th_percentile": 1060.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 321.06, "10th_percentile": 206.05, "90th_percentile": 328.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemoglobin chromotography", "code_information": [ { "code": "83021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.25, "discounted_cash": 194.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemoglobinopathy", "code_information": [ { "code": "83021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.25, "discounted_cash": 194.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glycosylated hemoglobin", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 174.75, "discounted_cash": 104.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 149.63, "10th_percentile": 134.67, "90th_percentile": 157.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 149.63, "10th_percentile": 134.67, "90th_percentile": 157.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 51.54, "10th_percentile": 41.23, "90th_percentile": 54.17, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.80, "10th_percentile": 50.77, "90th_percentile": 52.83, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "85", "median_amount": 72.15, "10th_percentile": 20.57, "90th_percentile": 171.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.61, "10th_percentile": 22.85, "90th_percentile": 149.49, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "372", "median_amount": 51.38, "10th_percentile": 50.51, "90th_percentile": 53.09, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 53.09, "10th_percentile": 50.51, "90th_percentile": 54.17, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "174", "median_amount": 53.09, "10th_percentile": 50.51, "90th_percentile": 53.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.65, "10th_percentile": 47.31, "90th_percentile": 160.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.65, "10th_percentile": 47.31, "90th_percentile": 160.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "117", "median_amount": 47.54, "10th_percentile": 41.59, "90th_percentile": 59.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "17", "median_amount": 160.98, "10th_percentile": 98.50, "90th_percentile": 160.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "17", "median_amount": 160.98, "10th_percentile": 98.50, "90th_percentile": 160.98, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glycosylated hemoglobin test", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 174.75, "discounted_cash": 104.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 149.63, "10th_percentile": 134.67, "90th_percentile": 157.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 149.63, "10th_percentile": 134.67, "90th_percentile": 157.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 51.54, "10th_percentile": 41.23, "90th_percentile": 54.17, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.80, "10th_percentile": 50.77, "90th_percentile": 52.83, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "85", "median_amount": 72.15, "10th_percentile": 20.57, "90th_percentile": 171.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.61, "10th_percentile": 22.85, "90th_percentile": 149.49, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "372", "median_amount": 51.38, "10th_percentile": 50.51, "90th_percentile": 53.09, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 53.09, "10th_percentile": 50.51, "90th_percentile": 54.17, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "174", "median_amount": 53.09, "10th_percentile": 50.51, "90th_percentile": 53.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.65, "10th_percentile": 47.31, "90th_percentile": 160.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.65, "10th_percentile": 47.31, "90th_percentile": 160.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "117", "median_amount": 47.54, "10th_percentile": 41.59, "90th_percentile": 59.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "17", "median_amount": 160.98, "10th_percentile": 98.50, "90th_percentile": 160.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "17", "median_amount": 160.98, "10th_percentile": 98.50, "90th_percentile": 160.98, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Blood methemoglobin assay", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19.25, "discounted_cash": 11.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemoglobin methmoglobin quan", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19.25, "discounted_cash": 11.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.00, "discounted_cash": 193.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 93.12, "10th_percentile": 93.12, "90th_percentile": 93.12, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.83, "10th_percentile": 97.83, "90th_percentile": 97.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.47, "10th_percentile": 83.79, "90th_percentile": 87.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.00, "discounted_cash": 193.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 93.12, "10th_percentile": 93.12, "90th_percentile": 93.12, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.83, "10th_percentile": 97.83, "90th_percentile": 97.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.47, "10th_percentile": 83.79, "90th_percentile": 87.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of corticosteroids 17", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.75, "discounted_cash": 193.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydroxycorticosteroids17", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.75, "discounted_cash": 193.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "5hiaa (serotonin)", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.75, "discounted_cash": 139.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of 5-hiaa", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.75, "discounted_cash": 139.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay nonantibody", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.75, "discounted_cash": 130.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.30, "10th_percentile": 45.57, "90th_percentile": 61.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.45, "10th_percentile": 60.23, "90th_percentile": 62.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.38, "10th_percentile": 56.38, "90th_percentile": 56.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brain natriuretic peptide", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 704.75, "discounted_cash": 422.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.50, "10th_percentile": 97.50, "90th_percentile": 97.50, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.72, "10th_percentile": 96.01, "90th_percentile": 100.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ria nonantibody", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 704.75, "discounted_cash": 422.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.50, "10th_percentile": 97.50, "90th_percentile": 97.50, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.72, "10th_percentile": 96.01, "90th_percentile": 100.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay quant nos nonab", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 310.50, "discounted_cash": 186.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.29, "10th_percentile": 73.29, "90th_percentile": 73.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.15, "10th_percentile": 20.24, "90th_percentile": 82.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.06, "10th_percentile": 90.24, "90th_percentile": 93.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.57, "10th_percentile": 105.57, "90th_percentile": 105.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyrotropin receptor antibody", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 310.50, "discounted_cash": 186.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.29, "10th_percentile": 73.29, "90th_percentile": 73.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.15, "10th_percentile": 20.24, "90th_percentile": 82.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.06, "10th_percentile": 90.24, "90th_percentile": 93.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.57, "10th_percentile": 105.57, "90th_percentile": 105.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of insulin", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 205.75, "discounted_cash": 123.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.98, "10th_percentile": 59.57, "90th_percentile": 60.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.51, "10th_percentile": 59.47, "90th_percentile": 62.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.25, "10th_percentile": 53.25, "90th_percentile": 55.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insulin total", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 205.75, "discounted_cash": 123.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.98, "10th_percentile": 59.57, "90th_percentile": 60.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.51, "10th_percentile": 59.47, "90th_percentile": 62.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 53.25, "10th_percentile": 53.25, "90th_percentile": 55.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 105.08, "10th_percentile": 105.08, "90th_percentile": 105.08, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 105.08, "10th_percentile": 105.08, "90th_percentile": 105.08, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 34.41, "10th_percentile": 28.95, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.78, "10th_percentile": 37.62, "90th_percentile": 114.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 109.34, "90th_percentile": 113.85, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 34.33, "10th_percentile": 33.72, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.47, "10th_percentile": 33.72, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 35.47, "10th_percentile": 33.73, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 69.66, "10th_percentile": 39.34, "90th_percentile": 99.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 69.66, "10th_percentile": 39.34, "90th_percentile": 99.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 31.76, "10th_percentile": 28.75, "90th_percentile": 39.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 104.90, "10th_percentile": 102.78, "90th_percentile": 107.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 104.90, "10th_percentile": 102.78, "90th_percentile": 107.02, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iron (fe)", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 105.08, "10th_percentile": 105.08, "90th_percentile": 105.08, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 105.08, "10th_percentile": 105.08, "90th_percentile": 105.08, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 34.41, "10th_percentile": 28.95, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.78, "10th_percentile": 37.62, "90th_percentile": 114.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 111.59, "10th_percentile": 109.34, "90th_percentile": 113.85, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 34.33, "10th_percentile": 33.72, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.47, "10th_percentile": 33.72, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 35.47, "10th_percentile": 33.73, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 69.66, "10th_percentile": 39.34, "90th_percentile": 99.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 69.66, "10th_percentile": 39.34, "90th_percentile": 99.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 31.76, "10th_percentile": 28.75, "90th_percentile": 39.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 104.90, "10th_percentile": 102.78, "90th_percentile": 107.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 104.90, "10th_percentile": 102.78, "90th_percentile": 107.02, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iron binding test", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 157.00, "discounted_cash": 94.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 141.30, "10th_percentile": 141.30, "90th_percentile": 141.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 141.30, "10th_percentile": 141.30, "90th_percentile": 141.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.51, "10th_percentile": 38.94, "90th_percentile": 48.67, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 153.86, "10th_percentile": 153.86, "90th_percentile": 153.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.94, "10th_percentile": 4.94, "90th_percentile": 4.94, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 46.16, "10th_percentile": 45.42, "90th_percentile": 47.70, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.70, "10th_percentile": 46.10, "90th_percentile": 48.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 47.70, "10th_percentile": 45.43, "90th_percentile": 47.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 93.66, "10th_percentile": 52.89, "90th_percentile": 134.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 93.66, "10th_percentile": 52.89, "90th_percentile": 134.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 41.68, "10th_percentile": 37.70, "90th_percentile": 52.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 144.63, "10th_percentile": 144.63, "90th_percentile": 144.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 144.63, "10th_percentile": 144.63, "90th_percentile": 144.63, "methodology": "percent of total billed charges" } ] } ] }, { "description": "T i b c", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 157.00, "discounted_cash": 94.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 141.30, "10th_percentile": 141.30, "90th_percentile": 141.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 141.30, "10th_percentile": 141.30, "90th_percentile": 141.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.51, "10th_percentile": 38.94, "90th_percentile": 48.67, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 153.86, "10th_percentile": 153.86, "90th_percentile": 153.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.94, "10th_percentile": 4.94, "90th_percentile": 4.94, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 46.16, "10th_percentile": 45.42, "90th_percentile": 47.70, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.70, "10th_percentile": 46.10, "90th_percentile": 48.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 47.70, "10th_percentile": 45.43, "90th_percentile": 47.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 93.66, "10th_percentile": 52.89, "90th_percentile": 134.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 93.66, "10th_percentile": 52.89, "90th_percentile": 134.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 41.68, "10th_percentile": 37.70, "90th_percentile": 52.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 144.63, "10th_percentile": 144.63, "90th_percentile": 144.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 144.63, "10th_percentile": 144.63, "90th_percentile": 144.63, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay 17- ketosteroids", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 230.00, "discounted_cash": 138.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketosteroid 17-total", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 230.00, "discounted_cash": 138.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lactic acid", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 124.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 168.48, "10th_percentile": 153.50, "90th_percentile": 183.46, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 168.48, "10th_percentile": 153.50, "90th_percentile": 183.46, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "95", "median_amount": 61.38, "10th_percentile": 25.10, "90th_percentile": 64.48, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.16, "10th_percentile": 60.16, "90th_percentile": 60.16, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "158", "median_amount": 203.84, "10th_percentile": 194.04, "90th_percentile": 203.84, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 203.84, "10th_percentile": 194.04, "90th_percentile": 399.84, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 61.15, "10th_percentile": 60.15, "90th_percentile": 63.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 48.12, "10th_percentile": 44.92, "90th_percentile": 64.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "259", "median_amount": 63.20, "10th_percentile": 60.16, "90th_percentile": 63.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 182.40, "10th_percentile": 101.10, "90th_percentile": 191.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 182.40, "10th_percentile": 101.10, "90th_percentile": 191.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "52", "median_amount": 56.58, "10th_percentile": 4.87, "90th_percentile": 70.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "14", "median_amount": 191.61, "10th_percentile": 149.48, "90th_percentile": 377.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "14", "median_amount": 191.61, "10th_percentile": 149.48, "90th_percentile": 377.69, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Latic acid", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 124.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 168.48, "10th_percentile": 153.50, "90th_percentile": 183.46, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 168.48, "10th_percentile": 153.50, "90th_percentile": 183.46, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "95", "median_amount": 61.38, "10th_percentile": 25.10, "90th_percentile": 64.48, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.16, "10th_percentile": 60.16, "90th_percentile": 60.16, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "158", "median_amount": 203.84, "10th_percentile": 194.04, "90th_percentile": 203.84, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 203.84, "10th_percentile": 194.04, "90th_percentile": 399.84, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 61.15, "10th_percentile": 60.15, "90th_percentile": 63.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 48.12, "10th_percentile": 44.92, "90th_percentile": 64.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "259", "median_amount": 63.20, "10th_percentile": 60.16, "90th_percentile": 63.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 182.40, "10th_percentile": 101.10, "90th_percentile": 191.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 182.40, "10th_percentile": 101.10, "90th_percentile": 191.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "52", "median_amount": 56.58, "10th_percentile": 4.87, "90th_percentile": 70.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "14", "median_amount": 191.61, "10th_percentile": 149.48, "90th_percentile": 377.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "14", "median_amount": 191.61, "10th_percentile": 149.48, "90th_percentile": 377.69, "methodology": "percent of total billed charges" } ] } ] }, { "description": "L d h", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.75, "discounted_cash": 65.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.57, "10th_percentile": 90.89, "90th_percentile": 106.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.45, "10th_percentile": 30.84, "90th_percentile": 32.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.71, "10th_percentile": 33.71, "90th_percentile": 33.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.04, "10th_percentile": 31.45, "90th_percentile": 33.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 100.18, "10th_percentile": 100.18, "90th_percentile": 100.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 100.18, "10th_percentile": 100.18, "90th_percentile": 100.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.28, "10th_percentile": 30.32, "90th_percentile": 36.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lactate (ld) (ldh) enzyme", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.75, "discounted_cash": 65.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.57, "10th_percentile": 90.89, "90th_percentile": 106.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.45, "10th_percentile": 30.84, "90th_percentile": 32.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.71, "10th_percentile": 33.71, "90th_percentile": 33.71, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.04, "10th_percentile": 31.45, "90th_percentile": 33.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 100.18, "10th_percentile": 100.18, "90th_percentile": 100.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 100.18, "10th_percentile": 100.18, "90th_percentile": 100.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.28, "10th_percentile": 30.32, "90th_percentile": 36.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ldh enzymes", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 229.75, "discounted_cash": 137.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ldh isoenzyme", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 229.75, "discounted_cash": 137.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.75, "discounted_cash": 130.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.09, "10th_percentile": 64.23, "90th_percentile": 65.94, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.04, "10th_percentile": 74.04, "90th_percentile": 74.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lead level", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.75, "discounted_cash": 130.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.09, "10th_percentile": 64.23, "90th_percentile": 65.94, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.04, "10th_percentile": 74.04, "90th_percentile": 74.04, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "51", "median_amount": 38.44, "10th_percentile": 29.81, "90th_percentile": 38.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.85, "10th_percentile": 35.85, "90th_percentile": 35.85, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "74", "median_amount": 121.52, "10th_percentile": 115.64, "90th_percentile": 121.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.52, "10th_percentile": 117.40, "90th_percentile": 121.52, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "157", "median_amount": 36.46, "10th_percentile": 35.85, "90th_percentile": 37.67, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 29.16, "10th_percentile": 28.67, "90th_percentile": 38.44, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "138", "median_amount": 37.68, "10th_percentile": 35.85, "90th_percentile": 37.68, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 108.70, "10th_percentile": 108.70, "90th_percentile": 112.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 108.70, "10th_percentile": 108.70, "90th_percentile": 112.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 32.10, "10th_percentile": 12.68, "90th_percentile": 42.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 114.23, "10th_percentile": 97.66, "90th_percentile": 114.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 114.23, "10th_percentile": 97.66, "90th_percentile": 114.56, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "51", "median_amount": 38.44, "10th_percentile": 29.81, "90th_percentile": 38.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.85, "10th_percentile": 35.85, "90th_percentile": 35.85, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "74", "median_amount": 121.52, "10th_percentile": 115.64, "90th_percentile": 121.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.52, "10th_percentile": 117.40, "90th_percentile": 121.52, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "157", "median_amount": 36.46, "10th_percentile": 35.85, "90th_percentile": 37.67, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 29.16, "10th_percentile": 28.67, "90th_percentile": 38.44, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "138", "median_amount": 37.68, "10th_percentile": 35.85, "90th_percentile": 37.68, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 108.70, "10th_percentile": 108.70, "90th_percentile": 112.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 108.70, "10th_percentile": 108.70, "90th_percentile": 112.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 32.10, "10th_percentile": 12.68, "90th_percentile": 42.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 114.23, "10th_percentile": 97.66, "90th_percentile": 114.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 114.23, "10th_percentile": 97.66, "90th_percentile": 114.56, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of lipoprotein(a)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 257.25, "discounted_cash": 154.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.64, "10th_percentile": 72.75, "90th_percentile": 75.64, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.16, "10th_percentile": 78.16, "90th_percentile": 78.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.98, "10th_percentile": 69.98, "90th_percentile": 69.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipoprotein blood (a)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 257.25, "discounted_cash": 154.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.64, "10th_percentile": 72.75, "90th_percentile": 75.64, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.16, "10th_percentile": 78.16, "90th_percentile": 78.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.98, "10th_percentile": 69.98, "90th_percentile": 69.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay lipoprotein pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 831.25, "discounted_cash": 498.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lp-pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 831.25, "discounted_cash": 498.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipoprotein analysis", "code_information": [ { "code": "83704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 42.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipoprotein bld quan part", "code_information": [ { "code": "83704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 42.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lipoprotein", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.50, "discounted_cash": 88.50, "minimum": 8.11, "maximum": 23.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 23.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 23.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 8.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hdl cholesterol", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.50, "discounted_cash": 88.50, "minimum": 8.11, "maximum": 23.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 23.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 23.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 8.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of blood lipoprotein", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.75, "discounted_cash": 113.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.34, "10th_percentile": 57.34, "90th_percentile": 57.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ldl cholesterol", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.75, "discounted_cash": 113.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.34, "10th_percentile": 57.34, "90th_percentile": 57.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.50, "discounted_cash": 72.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 103.28, "10th_percentile": 90.06, "90th_percentile": 103.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 103.28, "10th_percentile": 90.06, "90th_percentile": 103.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "113", "median_amount": 37.36, "10th_percentile": 29.89, "90th_percentile": 37.36, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.86, "10th_percentile": 34.86, "90th_percentile": 34.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "191", "median_amount": 118.09, "10th_percentile": 73.13, "90th_percentile": 118.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 118.09, "10th_percentile": 80.55, "90th_percentile": 118.09, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "448", "median_amount": 35.43, "10th_percentile": 34.86, "90th_percentile": 36.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 34.86, "10th_percentile": 27.89, "90th_percentile": 37.36, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "374", "median_amount": 36.62, "10th_percentile": 34.86, "90th_percentile": 36.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 105.71, "10th_percentile": 32.47, "90th_percentile": 111.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 105.71, "10th_percentile": 32.47, "90th_percentile": 111.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "73", "median_amount": 32.78, "10th_percentile": 27.31, "90th_percentile": 40.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "11", "median_amount": 111.00, "10th_percentile": 36.62, "90th_percentile": 111.00, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "11", "median_amount": 111.00, "10th_percentile": 36.62, "90th_percentile": 111.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.50, "discounted_cash": 72.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 103.28, "10th_percentile": 90.06, "90th_percentile": 103.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 103.28, "10th_percentile": 90.06, "90th_percentile": 103.28, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "113", "median_amount": 37.36, "10th_percentile": 29.89, "90th_percentile": 37.36, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.86, "10th_percentile": 34.86, "90th_percentile": 34.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "191", "median_amount": 118.09, "10th_percentile": 73.13, "90th_percentile": 118.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 118.09, "10th_percentile": 80.55, "90th_percentile": 118.09, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "448", "median_amount": 35.43, "10th_percentile": 34.86, "90th_percentile": 36.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 34.86, "10th_percentile": 27.89, "90th_percentile": 37.36, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "374", "median_amount": 36.62, "10th_percentile": 34.86, "90th_percentile": 36.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 105.71, "10th_percentile": 32.47, "90th_percentile": 111.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 105.71, "10th_percentile": 32.47, "90th_percentile": 111.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "73", "median_amount": 32.78, "10th_percentile": 27.31, "90th_percentile": 40.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "11", "median_amount": 111.00, "10th_percentile": 36.62, "90th_percentile": 111.00, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "11", "median_amount": 111.00, "10th_percentile": 36.62, "90th_percentile": 111.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 304.25, "discounted_cash": 182.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.25, "10th_percentile": 22.25, "90th_percentile": 22.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.19, "10th_percentile": 85.19, "90th_percentile": 85.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 304.25, "discounted_cash": 182.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.25, "10th_percentile": 22.25, "90th_percentile": 22.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.19, "10th_percentile": 85.19, "90th_percentile": 85.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of myoglobin", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 232.50, "discounted_cash": 139.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Myoglobin serum", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 232.50, "discounted_cash": 139.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of natriuretic peptide", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 704.75, "discounted_cash": 422.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 218.47, "10th_percentile": 218.47, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 218.47, "10th_percentile": 218.47, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 208.01, "10th_percentile": 166.41, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "98", "median_amount": 657.58, "10th_percentile": 86.13, "90th_percentile": 690.65, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 657.58, "10th_percentile": 171.79, "90th_percentile": 690.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "72", "median_amount": 207.20, "10th_percentile": 203.85, "90th_percentile": 214.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 203.85, "10th_percentile": 163.08, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "79", "median_amount": 214.11, "10th_percentile": 203.85, "90th_percentile": 214.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 191.70, "10th_percentile": 157.94, "90th_percentile": 215.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 366.93, "10th_percentile": 244.67, "90th_percentile": 488.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 366.93, "10th_percentile": 244.67, "90th_percentile": 488.89, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Brain natriuretic peptide", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 704.75, "discounted_cash": 422.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 218.47, "10th_percentile": 218.47, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 218.47, "10th_percentile": 218.47, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 208.01, "10th_percentile": 166.41, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "98", "median_amount": 657.58, "10th_percentile": 86.13, "90th_percentile": 690.65, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 657.58, "10th_percentile": 171.79, "90th_percentile": 690.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "72", "median_amount": 207.20, "10th_percentile": 203.85, "90th_percentile": 214.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 203.85, "10th_percentile": 163.08, "90th_percentile": 218.47, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "79", "median_amount": 214.11, "10th_percentile": 203.85, "90th_percentile": 214.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 191.70, "10th_percentile": 157.94, "90th_percentile": 215.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 366.93, "10th_percentile": 244.67, "90th_percentile": 488.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 366.93, "10th_percentile": 244.67, "90th_percentile": 488.89, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay nephelometry not spec", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 244.50, "discounted_cash": 146.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 151.59, "10th_percentile": 151.59, "90th_percentile": 151.59, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 148.56, "10th_percentile": 142.85, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.43, "10th_percentile": 12.76, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Free kappa light chains", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 244.50, "discounted_cash": 146.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 151.59, "10th_percentile": 151.59, "90th_percentile": 151.59, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 148.56, "10th_percentile": 142.85, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.43, "10th_percentile": 12.76, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "5' nucleotidase", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.50, "discounted_cash": 120.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of nucleotidase", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.50, "discounted_cash": 120.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylmalonic acid", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 381.00, "discounted_cash": 228.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.20, "10th_percentile": 110.20, "90th_percentile": 110.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.75, "10th_percentile": 115.75, "90th_percentile": 115.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.63, "10th_percentile": 103.63, "90th_percentile": 103.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Organic acid single quant", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 381.00, "discounted_cash": 228.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.20, "10th_percentile": 110.20, "90th_percentile": 110.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.75, "10th_percentile": 115.75, "90th_percentile": 115.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.63, "10th_percentile": 103.63, "90th_percentile": 103.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of blood osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 71.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.89, "10th_percentile": 36.89, "90th_percentile": 36.89, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.67, "10th_percentile": 14.67, "90th_percentile": 14.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.99, "10th_percentile": 34.58, "90th_percentile": 35.80, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.16, "10th_percentile": 36.16, "90th_percentile": 36.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Serum osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 71.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.89, "10th_percentile": 36.89, "90th_percentile": 36.89, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.67, "10th_percentile": 14.67, "90th_percentile": 14.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.99, "10th_percentile": 34.58, "90th_percentile": 35.80, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.16, "10th_percentile": 36.16, "90th_percentile": 36.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 122.75, "discounted_cash": 73.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.12, "10th_percentile": 36.38, "90th_percentile": 37.86, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.29, "10th_percentile": 120.29, "90th_percentile": 120.29, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.78, "10th_percentile": 35.53, "90th_percentile": 36.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.29, "10th_percentile": 37.29, "90th_percentile": 37.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 122.75, "discounted_cash": 73.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.12, "10th_percentile": 36.38, "90th_percentile": 37.86, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.29, "10th_percentile": 120.29, "90th_percentile": 120.29, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.78, "10th_percentile": 35.53, "90th_percentile": 36.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.29, "10th_percentile": 37.29, "90th_percentile": 37.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 259.75, "discounted_cash": 155.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 259.75, "discounted_cash": 155.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of parathormone", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 741.25, "discounted_cash": 444.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 229.79, "10th_percentile": 173.57, "90th_percentile": 229.79, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 199.87, "10th_percentile": 30.50, "90th_percentile": 460.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "102", "median_amount": 217.93, "10th_percentile": 208.19, "90th_percentile": 225.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 219.80, "10th_percentile": 214.40, "90th_percentile": 229.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "58", "median_amount": 225.20, "10th_percentile": 214.41, "90th_percentile": 225.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 191.97, "10th_percentile": 191.97, "90th_percentile": 191.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 191.97, "10th_percentile": 191.97, "90th_percentile": 191.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 201.62, "10th_percentile": 174.79, "90th_percentile": 201.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.84, "10th_percentile": 682.84, "90th_percentile": 682.84, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.84, "10th_percentile": 682.84, "90th_percentile": 682.84, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Parathyroid c-terminal", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 741.25, "discounted_cash": 444.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 229.79, "10th_percentile": 173.57, "90th_percentile": 229.79, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 199.87, "10th_percentile": 30.50, "90th_percentile": 460.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "102", "median_amount": 217.93, "10th_percentile": 208.19, "90th_percentile": 225.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 219.80, "10th_percentile": 214.40, "90th_percentile": 229.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "58", "median_amount": 225.20, "10th_percentile": 214.41, "90th_percentile": 225.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 191.97, "10th_percentile": 191.97, "90th_percentile": 191.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 191.97, "10th_percentile": 191.97, "90th_percentile": 191.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 201.62, "10th_percentile": 174.79, "90th_percentile": 201.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.84, "10th_percentile": 682.84, "90th_percentile": 682.84, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.84, "10th_percentile": 682.84, "90th_percentile": 682.84, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay for phencyclidine", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 269.75, "discounted_cash": 161.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pcp quan assay", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 269.75, "discounted_cash": 161.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay for calprotectin fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 352.50, "discounted_cash": 211.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.65, "10th_percentile": 104.54, "90th_percentile": 108.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 154.41, "10th_percentile": 154.41, "90th_percentile": 154.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 312.99, "10th_percentile": 312.99, "90th_percentile": 312.99, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.78, "10th_percentile": 102.10, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.28, "10th_percentile": 109.28, "90th_percentile": 109.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 95.88, "10th_percentile": 95.88, "90th_percentile": 95.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calprotection fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 352.50, "discounted_cash": 211.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.65, "10th_percentile": 104.54, "90th_percentile": 108.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 154.41, "10th_percentile": 154.41, "90th_percentile": 154.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 312.99, "10th_percentile": 312.99, "90th_percentile": 312.99, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.78, "10th_percentile": 102.10, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.28, "10th_percentile": 109.28, "90th_percentile": 109.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 95.88, "10th_percentile": 95.88, "90th_percentile": 95.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of blood pku", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 99.00, "discounted_cash": 59.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenylalaine (pku)", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 99.00, "discounted_cash": 59.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acid phosphatase", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 137.50, "discounted_cash": 82.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay acid phosphatase", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 137.50, "discounted_cash": 82.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alkaline phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay alkaline phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alkaline phosphatase isoenzym", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 265.75, "discounted_cash": 159.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.74, "10th_percentile": 80.74, "90th_percentile": 80.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay alkaline phosphatases", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 265.75, "discounted_cash": 159.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.74, "10th_percentile": 80.74, "90th_percentile": 80.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.50, "discounted_cash": 51.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.51, "10th_percentile": 26.51, "90th_percentile": 26.51, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.79, "10th_percentile": 82.12, "90th_percentile": 83.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.72, "10th_percentile": 26.72, "90th_percentile": 26.72, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "63", "median_amount": 25.14, "10th_percentile": 24.69, "90th_percentile": 25.98, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.51, "10th_percentile": 25.21, "90th_percentile": 26.51, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "53", "median_amount": 25.98, "10th_percentile": 24.69, "90th_percentile": 25.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.10, "10th_percentile": 22.10, "90th_percentile": 23.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.50, "discounted_cash": 51.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.51, "10th_percentile": 26.51, "90th_percentile": 26.51, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.79, "10th_percentile": 82.12, "90th_percentile": 83.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.72, "10th_percentile": 26.72, "90th_percentile": 26.72, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "63", "median_amount": 25.14, "10th_percentile": 24.69, "90th_percentile": 25.98, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.51, "10th_percentile": 25.21, "90th_percentile": 26.51, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "53", "median_amount": 25.98, "10th_percentile": 24.69, "90th_percentile": 25.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.10, "10th_percentile": 22.10, "90th_percentile": 23.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine phosphorus", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.60, "10th_percentile": 31.60, "90th_percentile": 31.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine phosphorus", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.60, "10th_percentile": 31.60, "90th_percentile": 31.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine porphyrins", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.25, "discounted_cash": 158.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine porphyrins", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.25, "discounted_cash": 158.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of serum potassium", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.75, "discounted_cash": 51.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.92, "10th_percentile": 23.27, "90th_percentile": 26.58, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.00, "10th_percentile": 6.00, "90th_percentile": 65.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.87, "10th_percentile": 79.87, "90th_percentile": 79.87, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 25.22, "10th_percentile": 24.76, "90th_percentile": 25.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.05, "10th_percentile": 25.41, "90th_percentile": 26.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium (k) serum", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.75, "discounted_cash": 51.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.92, "10th_percentile": 23.27, "90th_percentile": 26.58, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.00, "10th_percentile": 6.00, "90th_percentile": 65.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.87, "10th_percentile": 79.87, "90th_percentile": 79.87, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 25.22, "10th_percentile": 24.76, "90th_percentile": 25.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.05, "10th_percentile": 25.41, "90th_percentile": 26.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine potassium", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.25, "discounted_cash": 51.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.11, "10th_percentile": 25.11, "90th_percentile": 25.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.61, "10th_percentile": 24.61, "90th_percentile": 24.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.91, "10th_percentile": 25.91, "90th_percentile": 25.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine potassium", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.25, "discounted_cash": 51.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.11, "10th_percentile": 25.11, "90th_percentile": 25.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.61, "10th_percentile": 24.61, "90th_percentile": 24.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.91, "10th_percentile": 25.91, "90th_percentile": 25.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.00, "discounted_cash": 157.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.98, "10th_percentile": 64.98, "90th_percentile": 73.64, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 256.76, "10th_percentile": 256.76, "90th_percentile": 256.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.00, "discounted_cash": 157.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.98, "10th_percentile": 64.98, "90th_percentile": 73.64, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 256.76, "10th_percentile": 256.76, "90th_percentile": 256.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of progesterone", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 374.50, "discounted_cash": 224.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.20, "10th_percentile": 108.49, "90th_percentile": 109.92, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Progesterone", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 374.50, "discounted_cash": 224.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.20, "10th_percentile": 108.49, "90th_percentile": 109.92, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procalcintonin (pct)", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 489.00, "discounted_cash": 293.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 136.43, "10th_percentile": 124.30, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "72", "median_amount": 456.19, "10th_percentile": 285.44, "90th_percentile": 479.22, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 456.19, "10th_percentile": 456.19, "90th_percentile": 472.31, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "132", "median_amount": 143.77, "10th_percentile": 141.42, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 141.42, "10th_percentile": 113.85, "90th_percentile": 151.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 141.43, "10th_percentile": 141.43, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 394.60, "10th_percentile": 367.22, "90th_percentile": 421.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 394.60, "10th_percentile": 367.22, "90th_percentile": 421.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 133.01, "10th_percentile": 126.62, "90th_percentile": 166.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.47, "10th_percentile": 450.47, "90th_percentile": 450.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.47, "10th_percentile": 450.47, "90th_percentile": 450.47, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Procalcitonin (pct)", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 489.00, "discounted_cash": 293.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 136.43, "10th_percentile": 124.30, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "72", "median_amount": 456.19, "10th_percentile": 285.44, "90th_percentile": 479.22, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 456.19, "10th_percentile": 456.19, "90th_percentile": 472.31, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "132", "median_amount": 143.77, "10th_percentile": 141.42, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 141.42, "10th_percentile": 113.85, "90th_percentile": 151.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 141.43, "10th_percentile": 141.43, "90th_percentile": 148.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 394.60, "10th_percentile": 367.22, "90th_percentile": 421.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 394.60, "10th_percentile": 367.22, "90th_percentile": 421.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 133.01, "10th_percentile": 126.62, "90th_percentile": 166.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.47, "10th_percentile": 450.47, "90th_percentile": 450.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.47, "10th_percentile": 450.47, "90th_percentile": 450.47, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of prolactin", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 348.25, "discounted_cash": 208.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.37, "10th_percentile": 86.37, "90th_percentile": 86.37, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.97, "10th_percentile": 45.97, "90th_percentile": 45.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.25, "10th_percentile": 101.22, "90th_percentile": 105.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.96, "10th_percentile": 107.96, "90th_percentile": 107.96, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.81, "10th_percentile": 105.81, "90th_percentile": 105.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.17, "10th_percentile": 77.07, "90th_percentile": 90.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prolactin", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 348.25, "discounted_cash": 208.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.37, "10th_percentile": 86.37, "90th_percentile": 86.37, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.97, "10th_percentile": 45.97, "90th_percentile": 45.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.25, "10th_percentile": 101.22, "90th_percentile": 105.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.96, "10th_percentile": 107.96, "90th_percentile": 107.96, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.81, "10th_percentile": 105.81, "90th_percentile": 105.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.17, "10th_percentile": 77.07, "90th_percentile": 90.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of psa total", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 297.23, "10th_percentile": 269.89, "90th_percentile": 297.23, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 297.23, "10th_percentile": 269.89, "90th_percentile": 297.23, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.90, "10th_percentile": 78.78, "90th_percentile": 94.38, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.56, "10th_percentile": 70.58, "90th_percentile": 323.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 185.97, "10th_percentile": 185.97, "90th_percentile": 185.97, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 97.10, "10th_percentile": 95.55, "90th_percentile": 100.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.10, "10th_percentile": 97.10, "90th_percentile": 97.10, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.34, "10th_percentile": 95.55, "90th_percentile": 100.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 268.00, "10th_percentile": 239.02, "90th_percentile": 296.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 268.00, "10th_percentile": 239.02, "90th_percentile": 296.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 106.93, "10th_percentile": 85.54, "90th_percentile": 112.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 304.23, "10th_percentile": 266.55, "90th_percentile": 304.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 304.23, "10th_percentile": 266.55, "90th_percentile": 304.23, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Psa screening", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 297.23, "10th_percentile": 269.89, "90th_percentile": 297.23, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 297.23, "10th_percentile": 269.89, "90th_percentile": 297.23, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.90, "10th_percentile": 78.78, "90th_percentile": 94.38, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.56, "10th_percentile": 70.58, "90th_percentile": 323.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 185.97, "10th_percentile": 185.97, "90th_percentile": 185.97, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 97.10, "10th_percentile": 95.55, "90th_percentile": 100.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.10, "10th_percentile": 97.10, "90th_percentile": 97.10, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.34, "10th_percentile": 95.55, "90th_percentile": 100.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 268.00, "10th_percentile": 239.02, "90th_percentile": 296.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 268.00, "10th_percentile": 239.02, "90th_percentile": 296.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 106.93, "10th_percentile": 85.54, "90th_percentile": 112.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 304.23, "10th_percentile": 266.55, "90th_percentile": 304.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 304.23, "10th_percentile": 266.55, "90th_percentile": 304.23, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of psa free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.10, "10th_percentile": 97.10, "90th_percentile": 97.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.83, "10th_percentile": 89.83, "90th_percentile": 89.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Psa free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.10, "10th_percentile": 97.10, "90th_percentile": 97.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.83, "10th_percentile": 89.83, "90th_percentile": 89.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of protein serum", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 39.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.40, "10th_percentile": 19.40, "90th_percentile": 19.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.06, "10th_percentile": 20.06, "90th_percentile": 20.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total protein", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 39.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.40, "10th_percentile": 19.40, "90th_percentile": 19.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.06, "10th_percentile": 20.06, "90th_percentile": 20.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of protein urine", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 39.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.46, "10th_percentile": 18.93, "90th_percentile": 20.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.16, "10th_percentile": 8.23, "90th_percentile": 49.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 19.40, "10th_percentile": 19.06, "90th_percentile": 20.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 20.46, "10th_percentile": 19.06, "90th_percentile": 20.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 20.06, "10th_percentile": 19.07, "90th_percentile": 20.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.81, "10th_percentile": 57.81, "90th_percentile": 57.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.81, "10th_percentile": 57.81, "90th_percentile": 57.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.95, "10th_percentile": 16.16, "90th_percentile": 17.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 60.80, "10th_percentile": 60.80, "90th_percentile": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 60.80, "10th_percentile": 60.80, "90th_percentile": 60.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Urine total protein", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 39.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.46, "10th_percentile": 18.93, "90th_percentile": 20.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.16, "10th_percentile": 8.23, "90th_percentile": 49.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "67", "median_amount": 19.40, "10th_percentile": 19.06, "90th_percentile": 20.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 20.46, "10th_percentile": 19.06, "90th_percentile": 20.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 20.06, "10th_percentile": 19.07, "90th_percentile": 20.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.81, "10th_percentile": 57.81, "90th_percentile": 57.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.81, "10th_percentile": 57.81, "90th_percentile": 57.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.95, "10th_percentile": 16.16, "90th_percentile": 17.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 60.80, "10th_percentile": 60.80, "90th_percentile": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 60.80, "10th_percentile": 60.80, "90th_percentile": 60.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of protein other", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 72.25, "discounted_cash": 43.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.80, "10th_percentile": 70.80, "90th_percentile": 70.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.96, "10th_percentile": 21.96, "90th_percentile": 21.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein spinal", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 72.25, "discounted_cash": 43.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.80, "10th_percentile": 70.80, "90th_percentile": 70.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.96, "10th_percentile": 21.96, "90th_percentile": 21.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein e-phoresis serum", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.83, "10th_percentile": 59.83, "90th_percentile": 59.83, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 180.07, "10th_percentile": 180.07, "90th_percentile": 180.07, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.74, "10th_percentile": 55.28, "90th_percentile": 58.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.83, "10th_percentile": 59.83, "90th_percentile": 59.83, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.64, "10th_percentile": 55.83, "90th_percentile": 58.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.50, "10th_percentile": 52.50, "90th_percentile": 52.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein electrophoresis", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.83, "10th_percentile": 59.83, "90th_percentile": 59.83, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 180.07, "10th_percentile": 180.07, "90th_percentile": 180.07, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.74, "10th_percentile": 55.28, "90th_percentile": 58.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.83, "10th_percentile": 59.83, "90th_percentile": 59.83, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.64, "10th_percentile": 55.83, "90th_percentile": 58.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.50, "10th_percentile": 52.50, "90th_percentile": 52.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of proinsulin", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 90.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Proinsulin", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 90.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of vitamin b-6", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 280.00, "discounted_cash": 168.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.64, "10th_percentile": 26.63, "90th_percentile": 26.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin b6 plasma", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 280.00, "discounted_cash": 168.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.64, "10th_percentile": 26.63, "90th_percentile": 26.66, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of renin", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 395.00, "discounted_cash": 237.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Renin (angiostensin)", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 395.00, "discounted_cash": 237.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of vitamin b-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin b2 whole bl", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of sex hormone globul", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 390.25, "discounted_cash": 234.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.85, "10th_percentile": 69.85, "90th_percentile": 69.85, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.74, "10th_percentile": 113.43, "90th_percentile": 117.41, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 118.57, "10th_percentile": 118.57, "90th_percentile": 118.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.05, "10th_percentile": 94.51, "90th_percentile": 105.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 359.50, "10th_percentile": 359.50, "90th_percentile": 359.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 359.50, "10th_percentile": 359.50, "90th_percentile": 359.50, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sex binding hormone globulin", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 390.25, "discounted_cash": 234.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.85, "10th_percentile": 69.85, "90th_percentile": 69.85, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.74, "10th_percentile": 113.43, "90th_percentile": 117.41, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 118.57, "10th_percentile": 118.57, "90th_percentile": 118.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.05, "10th_percentile": 94.51, "90th_percentile": 105.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 359.50, "10th_percentile": 359.50, "90th_percentile": 359.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 359.50, "10th_percentile": 359.50, "90th_percentile": 359.50, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of serum sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 86.75, "discounted_cash": 52.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.89, "10th_percentile": 26.89, "90th_percentile": 48.41, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.58, "10th_percentile": 6.58, "90th_percentile": 6.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.07, "10th_percentile": 79.07, "90th_percentile": 79.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium (na)", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 86.75, "discounted_cash": 52.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.89, "10th_percentile": 26.89, "90th_percentile": 48.41, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.58, "10th_percentile": 6.58, "90th_percentile": 6.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.07, "10th_percentile": 79.07, "90th_percentile": 79.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.25, "discounted_cash": 54.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.29, "10th_percentile": 27.17, "90th_percentile": 28.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.54, "10th_percentile": 71.54, "90th_percentile": 71.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.83, "10th_percentile": 26.35, "90th_percentile": 27.72, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.00, "10th_percentile": 23.84, "90th_percentile": 28.29, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.73, "10th_percentile": 27.73, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.25, "discounted_cash": 54.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.29, "10th_percentile": 27.17, "90th_percentile": 28.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.54, "10th_percentile": 71.54, "90th_percentile": 71.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.83, "10th_percentile": 26.35, "90th_percentile": 27.72, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.00, "10th_percentile": 23.84, "90th_percentile": 28.29, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.73, "10th_percentile": 27.73, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of somatomedin", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 382.00, "discounted_cash": 229.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.95, "10th_percentile": 106.95, "90th_percentile": 106.95, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Igf-1", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 382.00, "discounted_cash": 229.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.95, "10th_percentile": 106.95, "90th_percentile": 106.95, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of free testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 457.50, "discounted_cash": 274.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 411.75, "10th_percentile": 411.75, "90th_percentile": 411.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 411.75, "10th_percentile": 411.75, "90th_percentile": 411.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 135.01, "10th_percentile": 135.01, "90th_percentile": 135.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.24, "10th_percentile": 47.05, "90th_percentile": 235.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 134.50, "10th_percentile": 132.31, "90th_percentile": 138.99, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.83, "10th_percentile": 141.83, "90th_percentile": 141.83, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 139.00, "10th_percentile": 132.31, "90th_percentile": 139.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.45, "10th_percentile": 107.32, "90th_percentile": 124.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 421.45, "10th_percentile": 421.45, "90th_percentile": 421.45, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 421.45, "10th_percentile": 421.45, "90th_percentile": 421.45, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Testosterone free", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 457.50, "discounted_cash": 274.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 411.75, "10th_percentile": 411.75, "90th_percentile": 411.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 411.75, "10th_percentile": 411.75, "90th_percentile": 411.75, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 135.01, "10th_percentile": 135.01, "90th_percentile": 135.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.24, "10th_percentile": 47.05, "90th_percentile": 235.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 134.50, "10th_percentile": 132.31, "90th_percentile": 138.99, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 141.83, "10th_percentile": 141.83, "90th_percentile": 141.83, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 139.00, "10th_percentile": 132.31, "90th_percentile": 139.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.45, "10th_percentile": 107.32, "90th_percentile": 124.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 421.45, "10th_percentile": 421.45, "90th_percentile": 421.45, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 421.45, "10th_percentile": 421.45, "90th_percentile": 421.45, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of total testosterone", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 463.75, "discounted_cash": 278.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 375.64, "10th_percentile": 342.25, "90th_percentile": 409.03, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 375.64, "10th_percentile": 342.25, "90th_percentile": 409.03, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.31, "10th_percentile": 137.56, "90th_percentile": 143.07, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.54, "10th_percentile": 72.54, "90th_percentile": 72.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 136.35, "10th_percentile": 134.13, "90th_percentile": 140.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 143.76, "10th_percentile": 143.76, "90th_percentile": 143.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.89, "10th_percentile": 136.16, "90th_percentile": 140.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 120.09, "10th_percentile": 105.61, "90th_percentile": 126.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 427.21, "10th_percentile": 427.21, "90th_percentile": 427.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 427.21, "10th_percentile": 427.21, "90th_percentile": 427.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Testosterone total", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 463.75, "discounted_cash": 278.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 375.64, "10th_percentile": 342.25, "90th_percentile": 409.03, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 375.64, "10th_percentile": 342.25, "90th_percentile": 409.03, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.31, "10th_percentile": 137.56, "90th_percentile": 143.07, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.54, "10th_percentile": 72.54, "90th_percentile": 72.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 136.35, "10th_percentile": 134.13, "90th_percentile": 140.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 143.76, "10th_percentile": 143.76, "90th_percentile": 143.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.89, "10th_percentile": 136.16, "90th_percentile": 140.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 120.09, "10th_percentile": 105.61, "90th_percentile": 126.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 427.21, "10th_percentile": 427.21, "90th_percentile": 427.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 427.21, "10th_percentile": 427.21, "90th_percentile": 427.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bioavailable + free test", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 205.00, "discounted_cash": 123.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Testosterone bioavailable", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 205.00, "discounted_cash": 123.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of vitamin b-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 381.50, "discounted_cash": 228.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.16, "10th_percentile": 110.72, "90th_percentile": 115.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.36, "10th_percentile": 110.36, "90th_percentile": 114.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin b1 (thiamine) blood", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 381.50, "discounted_cash": 228.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.16, "10th_percentile": 110.72, "90th_percentile": 115.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.36, "10th_percentile": 110.36, "90th_percentile": 114.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of thyroglobulin", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Comprehensive thyrog", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of total thyroxine", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 123.75, "discounted_cash": 74.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.36, "10th_percentile": 32.22, "90th_percentile": 38.36, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.27, "10th_percentile": 121.27, "90th_percentile": 121.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.59, "10th_percentile": 35.68, "90th_percentile": 37.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.59, "10th_percentile": 36.13, "90th_percentile": 37.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.77, "10th_percentile": 35.77, "90th_percentile": 35.77, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.84, "10th_percentile": 32.19, "90th_percentile": 33.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroxine (pku)", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 123.75, "discounted_cash": 74.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.36, "10th_percentile": 32.22, "90th_percentile": 38.36, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.27, "10th_percentile": 121.27, "90th_percentile": 121.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.59, "10th_percentile": 35.68, "90th_percentile": 37.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.59, "10th_percentile": 36.13, "90th_percentile": 37.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.77, "10th_percentile": 35.77, "90th_percentile": 35.77, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.84, "10th_percentile": 32.19, "90th_percentile": 33.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of free thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.25, "discounted_cash": 97.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 116.82, "10th_percentile": 116.82, "90th_percentile": 116.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 116.82, "10th_percentile": 116.82, "90th_percentile": 116.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 49.10, "10th_percentile": 40.24, "90th_percentile": 50.30, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.95, "10th_percentile": 46.95, "90th_percentile": 46.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 142.76, "10th_percentile": 77.65, "90th_percentile": 159.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.44, "10th_percentile": 50.99, "90th_percentile": 110.79, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "95", "median_amount": 47.71, "10th_percentile": 46.94, "90th_percentile": 49.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.30, "10th_percentile": 48.11, "90th_percentile": 50.30, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "46", "median_amount": 49.30, "10th_percentile": 46.95, "90th_percentile": 49.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.75, "10th_percentile": 52.77, "90th_percentile": 138.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.75, "10th_percentile": 52.77, "90th_percentile": 138.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 44.14, "10th_percentile": 38.62, "90th_percentile": 55.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 142.33, "10th_percentile": 119.57, "90th_percentile": 146.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 142.33, "10th_percentile": 119.57, "90th_percentile": 146.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Thyroxine free", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.25, "discounted_cash": 97.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 116.82, "10th_percentile": 116.82, "90th_percentile": 116.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 116.82, "10th_percentile": 116.82, "90th_percentile": 116.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 49.10, "10th_percentile": 40.24, "90th_percentile": 50.30, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.95, "10th_percentile": 46.95, "90th_percentile": 46.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 142.76, "10th_percentile": 77.65, "90th_percentile": 159.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.44, "10th_percentile": 50.99, "90th_percentile": 110.79, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "95", "median_amount": 47.71, "10th_percentile": 46.94, "90th_percentile": 49.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.30, "10th_percentile": 48.11, "90th_percentile": 50.30, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "46", "median_amount": 49.30, "10th_percentile": 46.95, "90th_percentile": 49.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.75, "10th_percentile": 52.77, "90th_percentile": 138.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 95.75, "10th_percentile": 52.77, "90th_percentile": 138.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 44.14, "10th_percentile": 38.62, "90th_percentile": 55.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 142.33, "10th_percentile": 119.57, "90th_percentile": 146.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 142.33, "10th_percentile": 119.57, "90th_percentile": 146.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of thyroid activity", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 265.75, "discounted_cash": 159.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroxine binding globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 265.75, "discounted_cash": 159.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay thyroid stim hormone", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 202.75, "discounted_cash": 121.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 165.01, "10th_percentile": 145.98, "90th_percentile": 178.09, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 165.01, "10th_percentile": 145.98, "90th_percentile": 178.09, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "100", "median_amount": 59.83, "10th_percentile": 47.86, "90th_percentile": 62.85, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.12, "10th_percentile": 58.94, "90th_percentile": 61.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "102", "median_amount": 189.14, "10th_percentile": 39.87, "90th_percentile": 198.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.82, "10th_percentile": 26.85, "90th_percentile": 198.69, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "489", "median_amount": 59.61, "10th_percentile": 58.63, "90th_percentile": 61.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "68", "median_amount": 62.85, "10th_percentile": 58.63, "90th_percentile": 62.85, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "245", "median_amount": 61.60, "10th_percentile": 58.64, "90th_percentile": 61.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "13", "median_amount": 149.42, "10th_percentile": 57.24, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "13", "median_amount": 149.42, "10th_percentile": 57.24, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "124", "median_amount": 55.15, "10th_percentile": 48.26, "90th_percentile": 68.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "21", "median_amount": 177.79, "10th_percentile": 61.60, "90th_percentile": 186.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "21", "median_amount": 177.79, "10th_percentile": 61.60, "90th_percentile": 186.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "T s h", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 202.75, "discounted_cash": 121.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 165.01, "10th_percentile": 145.98, "90th_percentile": 178.09, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 165.01, "10th_percentile": 145.98, "90th_percentile": 178.09, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "100", "median_amount": 59.83, "10th_percentile": 47.86, "90th_percentile": 62.85, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.12, "10th_percentile": 58.94, "90th_percentile": 61.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "102", "median_amount": 189.14, "10th_percentile": 39.87, "90th_percentile": 198.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.82, "10th_percentile": 26.85, "90th_percentile": 198.69, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "489", "median_amount": 59.61, "10th_percentile": 58.63, "90th_percentile": 61.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "68", "median_amount": 62.85, "10th_percentile": 58.63, "90th_percentile": 62.85, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "245", "median_amount": 61.60, "10th_percentile": 58.64, "90th_percentile": 61.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "13", "median_amount": 149.42, "10th_percentile": 57.24, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "13", "median_amount": 149.42, "10th_percentile": 57.24, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "124", "median_amount": 55.15, "10th_percentile": 48.26, "90th_percentile": 68.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "21", "median_amount": 177.79, "10th_percentile": 61.60, "90th_percentile": 186.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "21", "median_amount": 177.79, "10th_percentile": 61.60, "90th_percentile": 186.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of tsi globulin", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 912.75, "discounted_cash": 547.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 153.16, "10th_percentile": 61.01, "90th_percentile": 245.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroid stimulating immunoglob", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 912.75, "discounted_cash": 547.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 153.16, "10th_percentile": 61.01, "90th_percentile": 245.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of vitamin e", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 78.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin e", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 78.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "S g o t (ast)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.69, "10th_percentile": 56.09, "90th_percentile": 89.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.34, "10th_percentile": 28.34, "90th_percentile": 28.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.71, "10th_percentile": 31.71, "90th_percentile": 31.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transferase (ast) (sgot)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.69, "10th_percentile": 56.09, "90th_percentile": 89.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.34, "10th_percentile": 28.34, "90th_percentile": 28.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.71, "10th_percentile": 31.71, "90th_percentile": 31.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alanine amino (alt) (sgpt)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 95.75, "discounted_cash": 57.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.07, "10th_percentile": 38.05, "90th_percentile": 84.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.11, "10th_percentile": 12.76, "90th_percentile": 25.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.56, "10th_percentile": 32.56, "90th_percentile": 32.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "S g p t (alt)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 95.75, "discounted_cash": 57.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.07, "10th_percentile": 38.05, "90th_percentile": 84.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.11, "10th_percentile": 12.76, "90th_percentile": 25.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.56, "10th_percentile": 32.56, "90th_percentile": 32.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 229.25, "discounted_cash": 137.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.40, "10th_percentile": 67.07, "90th_percentile": 69.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.31, "10th_percentile": 66.31, "90th_percentile": 66.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.36, "10th_percentile": 62.36, "90th_percentile": 62.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 229.25, "discounted_cash": 137.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.40, "10th_percentile": 67.07, "90th_percentile": 69.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.31, "10th_percentile": 66.31, "90th_percentile": 66.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.36, "10th_percentile": 62.36, "90th_percentile": 62.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of triglycerides", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.25, "discounted_cash": 61.95, "minimum": 5.68, "maximum": 16.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.36, "10th_percentile": 30.36, "90th_percentile": 30.36, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.37, "10th_percentile": 31.37, "90th_percentile": 31.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triglycerides", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.25, "discounted_cash": 61.95, "minimum": 5.68, "maximum": 16.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.36, "10th_percentile": 30.36, "90th_percentile": 30.36, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.37, "10th_percentile": 31.37, "90th_percentile": 31.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of thyroid (t3 or t4)", "code_information": [ { "code": "84479", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "T3 uptake", "code_information": [ { "code": "84479", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay triiodothyronine (t3)", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 255.00, "discounted_cash": 153.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.05, "10th_percentile": 79.05, "90th_percentile": 79.05, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.70, "10th_percentile": 115.70, "90th_percentile": 115.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.97, "10th_percentile": 73.74, "90th_percentile": 77.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.47, "10th_percentile": 77.47, "90th_percentile": 77.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 32.51, "10th_percentile": 32.51, "90th_percentile": 32.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 32.51, "10th_percentile": 32.51, "90th_percentile": 32.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.36, "10th_percentile": 69.36, "90th_percentile": 69.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 187.93, "10th_percentile": 187.93, "90th_percentile": 187.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 187.93, "10th_percentile": 187.93, "90th_percentile": 187.93, "methodology": "percent of total billed charges" } ] } ] }, { "description": "T3 ira", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 255.00, "discounted_cash": 153.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.05, "10th_percentile": 79.05, "90th_percentile": 79.05, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.70, "10th_percentile": 115.70, "90th_percentile": 115.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.97, "10th_percentile": 73.74, "90th_percentile": 77.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.47, "10th_percentile": 77.47, "90th_percentile": 77.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 32.51, "10th_percentile": 32.51, "90th_percentile": 32.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 32.51, "10th_percentile": 32.51, "90th_percentile": 32.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.36, "10th_percentile": 69.36, "90th_percentile": 69.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 187.93, "10th_percentile": 187.93, "90th_percentile": 187.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 187.93, "10th_percentile": 187.93, "90th_percentile": 187.93, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Free assay (ft-3)", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 304.25, "discounted_cash": 182.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.32, "10th_percentile": 90.72, "90th_percentile": 94.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.58, "10th_percentile": 179.58, "90th_percentile": 179.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 89.45, "10th_percentile": 88.02, "90th_percentile": 91.24, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.03, "10th_percentile": 88.03, "90th_percentile": 92.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 80.79, "10th_percentile": 78.82, "90th_percentile": 82.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 266.92, "10th_percentile": 266.92, "90th_percentile": 266.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 266.92, "10th_percentile": 266.92, "90th_percentile": 266.92, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Triiodothyronine free serum t3", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 304.25, "discounted_cash": 182.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.32, "10th_percentile": 90.72, "90th_percentile": 94.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.58, "10th_percentile": 179.58, "90th_percentile": 179.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 89.45, "10th_percentile": 88.02, "90th_percentile": 91.24, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.03, "10th_percentile": 88.03, "90th_percentile": 92.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 80.79, "10th_percentile": 78.82, "90th_percentile": 82.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 266.92, "10th_percentile": 266.92, "90th_percentile": 266.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 266.92, "10th_percentile": 266.92, "90th_percentile": 266.92, "methodology": "percent of total billed charges" } ] } ] }, { "description": "T3 reverse", "code_information": [ { "code": "84482", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 283.00, "discounted_cash": 169.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.88, "10th_percentile": 81.88, "90th_percentile": 81.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.14, "10th_percentile": 73.67, "90th_percentile": 76.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of troponin quant", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 224.00, "discounted_cash": 134.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 161.28, "10th_percentile": 98.11, "90th_percentile": 201.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 161.28, "10th_percentile": 98.11, "90th_percentile": 201.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "89", "median_amount": 69.44, "10th_percentile": 55.02, "90th_percentile": 70.25, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "126", "median_amount": 219.52, "10th_percentile": 143.13, "90th_percentile": 439.04, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 208.98, "10th_percentile": 101.41, "90th_percentile": 279.06, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 65.86, "10th_percentile": 64.79, "90th_percentile": 131.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 64.79, "10th_percentile": 51.83, "90th_percentile": 134.14, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "259", "median_amount": 68.06, "10th_percentile": 64.79, "90th_percentile": 136.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 180.76, "10th_percentile": 71.00, "90th_percentile": 321.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 180.76, "10th_percentile": 71.00, "90th_percentile": 321.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "55", "median_amount": 60.93, "10th_percentile": 50.48, "90th_percentile": 112.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 206.35, "10th_percentile": 181.25, "90th_percentile": 216.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 206.35, "10th_percentile": 181.25, "90th_percentile": 216.49, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Troponin-i", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 224.00, "discounted_cash": 134.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 161.28, "10th_percentile": 98.11, "90th_percentile": 201.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 161.28, "10th_percentile": 98.11, "90th_percentile": 201.60, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "89", "median_amount": 69.44, "10th_percentile": 55.02, "90th_percentile": 70.25, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "126", "median_amount": 219.52, "10th_percentile": 143.13, "90th_percentile": 439.04, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 208.98, "10th_percentile": 101.41, "90th_percentile": 279.06, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 65.86, "10th_percentile": 64.79, "90th_percentile": 131.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 64.79, "10th_percentile": 51.83, "90th_percentile": 134.14, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "259", "median_amount": 68.06, "10th_percentile": 64.79, "90th_percentile": 136.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 180.76, "10th_percentile": 71.00, "90th_percentile": 321.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 180.76, "10th_percentile": 71.00, "90th_percentile": 321.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "55", "median_amount": 60.93, "10th_percentile": 50.48, "90th_percentile": 112.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 206.35, "10th_percentile": 181.25, "90th_percentile": 216.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 206.35, "10th_percentile": 181.25, "90th_percentile": 216.49, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of urea nitrogen", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 71.25, "discounted_cash": 42.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.09, "10th_percentile": 19.00, "90th_percentile": 22.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 69.82, "10th_percentile": 55.86, "90th_percentile": 69.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.82, "10th_percentile": 69.82, "90th_percentile": 69.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 20.95, "10th_percentile": 20.58, "90th_percentile": 21.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.65, "10th_percentile": 20.58, "90th_percentile": 22.09, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.65, "10th_percentile": 20.58, "90th_percentile": 21.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.38, "10th_percentile": 19.38, "90th_percentile": 19.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "B u n (blood urea nitrogen)", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 71.25, "discounted_cash": 42.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.09, "10th_percentile": 19.00, "90th_percentile": 22.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 69.82, "10th_percentile": 55.86, "90th_percentile": 69.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.82, "10th_percentile": 69.82, "90th_percentile": 69.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 20.95, "10th_percentile": 20.58, "90th_percentile": 21.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.65, "10th_percentile": 20.58, "90th_percentile": 22.09, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.65, "10th_percentile": 20.58, "90th_percentile": 21.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.38, "10th_percentile": 19.38, "90th_percentile": 19.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine/urea-n", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.25, "discounted_cash": 60.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine urea nitrogen", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.25, "discounted_cash": 60.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of blood/uric acid", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.27, "10th_percentile": 23.25, "90th_percentile": 25.27, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.95, "10th_percentile": 5.11, "90th_percentile": 79.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "69", "median_amount": 23.96, "10th_percentile": 23.40, "90th_percentile": 24.76, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.27, "10th_percentile": 23.55, "90th_percentile": 25.27, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 24.77, "10th_percentile": 23.55, "90th_percentile": 24.77, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.11, "10th_percentile": 57.11, "90th_percentile": 57.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.11, "10th_percentile": 57.11, "90th_percentile": 57.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.17, "10th_percentile": 20.41, "90th_percentile": 27.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Uric acid", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.50, "discounted_cash": 48.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.27, "10th_percentile": 23.25, "90th_percentile": 25.27, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.95, "10th_percentile": 5.11, "90th_percentile": 79.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "69", "median_amount": 23.96, "10th_percentile": 23.40, "90th_percentile": 24.76, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.27, "10th_percentile": 23.55, "90th_percentile": 25.27, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 24.77, "10th_percentile": 23.55, "90th_percentile": 24.77, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.11, "10th_percentile": 57.11, "90th_percentile": 57.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.11, "10th_percentile": 57.11, "90th_percentile": 57.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.17, "10th_percentile": 20.41, "90th_percentile": 27.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine/uric acid", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.50, "discounted_cash": 54.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine uric acid", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.50, "discounted_cash": 54.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Test urine urobilinogen", "code_information": [ { "code": "84578", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.50, "discounted_cash": 48.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urobilinogen qualitative", "code_information": [ { "code": "84578", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.50, "discounted_cash": 48.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine vma", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.75, "discounted_cash": 167.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "V m a urine", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.75, "discounted_cash": 167.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of vitamin a", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.00, "discounted_cash": 69.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.10, "10th_percentile": 34.10, "90th_percentile": 34.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin a serum", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.00, "discounted_cash": 69.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.10, "10th_percentile": 34.10, "90th_percentile": 34.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of volatiles", "code_information": [ { "code": "84600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenol occupational", "code_information": [ { "code": "84600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of zinc", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 204.75, "discounted_cash": 122.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.20, "10th_percentile": 60.20, "90th_percentile": 60.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.47, "10th_percentile": 63.47, "90th_percentile": 63.47, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.21, "10th_percentile": 62.21, "90th_percentile": 62.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zinc level", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 204.75, "discounted_cash": 122.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.20, "10th_percentile": 60.20, "90th_percentile": 60.20, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.47, "10th_percentile": 63.47, "90th_percentile": 63.47, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.21, "10th_percentile": 62.21, "90th_percentile": 62.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of c-peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.75, "discounted_cash": 224.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.36, "10th_percentile": 103.36, "90th_percentile": 103.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.89, "10th_percentile": 109.89, "90th_percentile": 109.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.77, "10th_percentile": 96.77, "90th_percentile": 96.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C-peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.75, "discounted_cash": 224.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.36, "10th_percentile": 103.36, "90th_percentile": 103.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.89, "10th_percentile": 109.89, "90th_percentile": 109.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.77, "10th_percentile": 96.77, "90th_percentile": 96.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chorionic gonadotropin test", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 270.25, "discounted_cash": 162.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 194.58, "10th_percentile": 194.58, "90th_percentile": 194.58, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 194.58, "10th_percentile": 194.58, "90th_percentile": 194.58, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5.26, "10th_percentile": 5.26, "90th_percentile": 5.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Quantitative h c g", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 270.25, "discounted_cash": 162.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 194.58, "10th_percentile": 194.58, "90th_percentile": 194.58, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 194.58, "10th_percentile": 194.58, "90th_percentile": 194.58, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5.26, "10th_percentile": 5.26, "90th_percentile": 5.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chorionic gonadotropin assay", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.25, "discounted_cash": 81.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 97.38, "10th_percentile": 97.38, "90th_percentile": 97.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 97.38, "10th_percentile": 97.38, "90th_percentile": 97.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.77, "10th_percentile": 39.11, "90th_percentile": 39.77, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.12, "10th_percentile": 39.12, "90th_percentile": 41.10, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 124.59, "10th_percentile": 52.93, "90th_percentile": 124.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 124.59, "10th_percentile": 52.93, "90th_percentile": 124.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 35.91, "10th_percentile": 18.20, "90th_percentile": 45.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chronic gonadotropin (hcg)", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.25, "discounted_cash": 81.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 97.38, "10th_percentile": 97.38, "90th_percentile": 97.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 97.38, "10th_percentile": 97.38, "90th_percentile": 97.38, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.77, "10th_percentile": 39.11, "90th_percentile": 39.77, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.12, "10th_percentile": 39.12, "90th_percentile": 41.10, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 124.59, "10th_percentile": 52.93, "90th_percentile": 124.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 124.59, "10th_percentile": 52.93, "90th_percentile": 124.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 35.91, "10th_percentile": 18.20, "90th_percentile": 45.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bleeding time (simplate)", "code_information": [ { "code": "85002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 86.75, "discounted_cash": 52.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bleeding time test", "code_information": [ { "code": "85002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 86.75, "discounted_cash": 52.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Differential (manual)", "code_information": [ { "code": "85009", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.50, "discounted_cash": 54.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Manual diff wbc count b-coat", "code_information": [ { "code": "85009", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.50, "discounted_cash": 54.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hematocrit", "code_information": [ { "code": "85014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 25.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.63, "10th_percentile": 11.05, "90th_percentile": 13.19, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.17, "10th_percentile": 6.03, "90th_percentile": 6.31, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 12.64, "10th_percentile": 12.38, "90th_percentile": 13.06, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.07, "10th_percentile": 12.66, "90th_percentile": 13.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemoglobin", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 25.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.63, "10th_percentile": 11.84, "90th_percentile": 13.33, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 12.64, "10th_percentile": 12.38, "90th_percentile": 13.06, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.07, "10th_percentile": 12.66, "90th_percentile": 13.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.16, "10th_percentile": 11.99, "90th_percentile": 14.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cbc with auto differential", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.75, "discounted_cash": 83.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "13", "median_amount": 125.78, "10th_percentile": 100.62, "90th_percentile": 125.78, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "13", "median_amount": 125.78, "10th_percentile": 100.62, "90th_percentile": 125.78, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "287", "median_amount": 43.32, "10th_percentile": 32.98, "90th_percentile": 43.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.41, "10th_percentile": 25.82, "90th_percentile": 41.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "284", "median_amount": 130.34, "10th_percentile": 22.68, "90th_percentile": 136.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 133.64, "10th_percentile": 121.13, "90th_percentile": 136.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1155", "median_amount": 41.09, "10th_percentile": 40.41, "90th_percentile": 42.45, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "137", "median_amount": 42.45, "10th_percentile": 32.32, "90th_percentile": 43.32, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "718", "median_amount": 42.46, "10th_percentile": 40.41, "90th_percentile": 42.46, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "28", "median_amount": 102.99, "10th_percentile": 37.47, "90th_percentile": 128.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "28", "median_amount": 102.99, "10th_percentile": 37.47, "90th_percentile": 128.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "288", "median_amount": 38.02, "10th_percentile": 33.26, "90th_percentile": 47.52, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "40", "median_amount": 128.74, "10th_percentile": 42.46, "90th_percentile": 128.74, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "40", "median_amount": 128.74, "10th_percentile": 42.46, "90th_percentile": 128.74, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Complete cbc w/auto diff wbc", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.75, "discounted_cash": 83.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "13", "median_amount": 125.78, "10th_percentile": 100.62, "90th_percentile": 125.78, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "13", "median_amount": 125.78, "10th_percentile": 100.62, "90th_percentile": 125.78, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "287", "median_amount": 43.32, "10th_percentile": 32.98, "90th_percentile": 43.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.41, "10th_percentile": 25.82, "90th_percentile": 41.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "284", "median_amount": 130.34, "10th_percentile": 22.68, "90th_percentile": 136.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 133.64, "10th_percentile": 121.13, "90th_percentile": 136.95, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1155", "median_amount": 41.09, "10th_percentile": 40.41, "90th_percentile": 42.45, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "137", "median_amount": 42.45, "10th_percentile": 32.32, "90th_percentile": 43.32, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "718", "median_amount": 42.46, "10th_percentile": 40.41, "90th_percentile": 42.46, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "28", "median_amount": 102.99, "10th_percentile": 37.47, "90th_percentile": 128.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "28", "median_amount": 102.99, "10th_percentile": 37.47, "90th_percentile": 128.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "288", "median_amount": 38.02, "10th_percentile": 33.26, "90th_percentile": 47.52, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "40", "median_amount": 128.74, "10th_percentile": 42.46, "90th_percentile": 128.74, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "40", "median_amount": 128.74, "10th_percentile": 42.46, "90th_percentile": 128.74, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cbc", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 84.06, "10th_percentile": 81.58, "90th_percentile": 103.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 84.06, "10th_percentile": 81.58, "90th_percentile": 103.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 36.19, "10th_percentile": 28.95, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.83, "10th_percentile": 35.54, "90th_percentile": 36.12, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "55", "median_amount": 87.02, "10th_percentile": 15.69, "90th_percentile": 114.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "182", "median_amount": 34.33, "10th_percentile": 33.72, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 34.59, "10th_percentile": 33.72, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "93", "median_amount": 35.47, "10th_percentile": 33.73, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 87.80, "90th_percentile": 105.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 87.80, "90th_percentile": 105.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 31.76, "10th_percentile": 27.72, "90th_percentile": 39.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 55.70, "90th_percentile": 107.55, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 55.70, "90th_percentile": 107.55, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Complete cbc automated", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.75, "discounted_cash": 70.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 84.06, "10th_percentile": 81.58, "90th_percentile": 103.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 84.06, "10th_percentile": 81.58, "90th_percentile": 103.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 36.19, "10th_percentile": 28.95, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.83, "10th_percentile": 35.54, "90th_percentile": 36.12, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "55", "median_amount": 87.02, "10th_percentile": 15.69, "90th_percentile": 114.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "182", "median_amount": 34.33, "10th_percentile": 33.72, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 34.59, "10th_percentile": 33.72, "90th_percentile": 36.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "93", "median_amount": 35.47, "10th_percentile": 33.73, "90th_percentile": 35.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 87.80, "90th_percentile": 105.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 87.80, "90th_percentile": 105.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 31.76, "10th_percentile": 27.72, "90th_percentile": 39.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 55.70, "90th_percentile": 107.55, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 102.25, "10th_percentile": 55.70, "90th_percentile": 107.55, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Automated rbc count", "code_information": [ { "code": "85041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 36.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Q6pd qn bld and red", "code_information": [ { "code": "85041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 36.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Manual reticulocyte count", "code_information": [ { "code": "85044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.75, "discounted_cash": 46.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.35, "10th_percentile": 18.35, "90th_percentile": 18.35, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.24, "10th_percentile": 22.12, "90th_percentile": 23.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.10, "10th_percentile": 24.10, "90th_percentile": 24.10, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.49, "10th_percentile": 22.49, "90th_percentile": 23.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reticulocyte count", "code_information": [ { "code": "85044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.75, "discounted_cash": 46.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.35, "10th_percentile": 18.35, "90th_percentile": 18.35, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.24, "10th_percentile": 22.12, "90th_percentile": 23.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.10, "10th_percentile": 24.10, "90th_percentile": 24.10, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.49, "10th_percentile": 22.49, "90th_percentile": 23.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Automated leukocyte count", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 27.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "W b c", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 27.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Automated platelet count", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.75, "discounted_cash": 48.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.91, "10th_percentile": 20.40, "90th_percentile": 23.41, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.03, "10th_percentile": 25.03, "90th_percentile": 25.03, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelet count", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.75, "discounted_cash": 48.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.91, "10th_percentile": 20.40, "90th_percentile": 23.41, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.03, "10th_percentile": 25.03, "90th_percentile": 25.03, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot factor ii prothrom spec", "code_information": [ { "code": "85210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.25, "discounted_cash": 139.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.06, "10th_percentile": 65.83, "90th_percentile": 70.30, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.45, "10th_percentile": 63.45, "90th_percentile": 63.45, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prothrombin factor ii", "code_information": [ { "code": "85210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.25, "discounted_cash": 139.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.06, "10th_percentile": 65.83, "90th_percentile": 70.30, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.45, "10th_percentile": 63.45, "90th_percentile": 63.45, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blooc clot factor v test", "code_information": [ { "code": "85220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 317.25, "discounted_cash": 190.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.38, "10th_percentile": 96.38, "90th_percentile": 96.38, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Factor v labile factor", "code_information": [ { "code": "85220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 317.25, "discounted_cash": 190.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.38, "10th_percentile": 96.38, "90th_percentile": 96.38, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot factor viii ahg 1 stage", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 179.00, "discounted_cash": 107.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.28, "10th_percentile": 35.28, "90th_percentile": 35.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Factor viii activity", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 179.00, "discounted_cash": 107.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.28, "10th_percentile": 35.28, "90th_percentile": 35.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot factor viii vw ristoctn", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 412.00, "discounted_cash": 247.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 122.17, "10th_percentile": 119.77, "90th_percentile": 124.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vwf acivity", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 412.00, "discounted_cash": 247.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 122.17, "10th_percentile": 119.77, "90th_percentile": 124.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antithrombin iii activity", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 213.00, "discounted_cash": 127.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antithrombin iii antigen act", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 213.00, "discounted_cash": 127.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.61, "10th_percentile": 59.61, "90th_percentile": 59.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot inhibit prot c antigen", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 129.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.02, "10th_percentile": 60.94, "90th_percentile": 65.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.75, "10th_percentile": 58.75, "90th_percentile": 58.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clotting inhibitor; protein c", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 129.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.02, "10th_percentile": 60.94, "90th_percentile": 65.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.75, "10th_percentile": 58.75, "90th_percentile": 58.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot inhibit prot c activity", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 210.00, "discounted_cash": 126.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.05, "10th_percentile": 22.05, "90th_percentile": 22.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein c-functional", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 210.00, "discounted_cash": 126.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.05, "10th_percentile": 22.05, "90th_percentile": 22.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot inhibit prot s total", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.50, "discounted_cash": 125.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.36, "10th_percentile": 58.36, "90th_percentile": 58.36, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.71, "10th_percentile": 56.71, "90th_percentile": 56.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein s", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.50, "discounted_cash": 125.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.36, "10th_percentile": 58.36, "90th_percentile": 58.36, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.71, "10th_percentile": 56.71, "90th_percentile": 56.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot inhibit prot s free", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 125.00, "discounted_cash": 75.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.50, "10th_percentile": 28.47, "90th_percentile": 44.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein s-functional/free", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 125.00, "discounted_cash": 75.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.50, "10th_percentile": 28.47, "90th_percentile": 44.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fibrin degradation prod", "code_information": [ { "code": "85362", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fibrin degradation products", "code_information": [ { "code": "85362", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D-dimer plasma quantitative", "code_information": [ { "code": "85379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.00, "discounted_cash": 109.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 156.83, "10th_percentile": 156.83, "90th_percentile": 156.83, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 156.83, "10th_percentile": 156.83, "90th_percentile": 156.83, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 56.73, "10th_percentile": 51.32, "90th_percentile": 56.73, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 170.76, "10th_percentile": 111.64, "90th_percentile": 179.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.41, "10th_percentile": 133.41, "90th_percentile": 133.41, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "48", "median_amount": 53.80, "10th_percentile": 52.94, "90th_percentile": 54.34, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.73, "10th_percentile": 52.08, "90th_percentile": 56.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 55.60, "10th_percentile": 52.94, "90th_percentile": 55.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 103.96, "10th_percentile": 58.71, "90th_percentile": 149.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 103.96, "10th_percentile": 58.71, "90th_percentile": 149.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 49.78, "10th_percentile": 22.99, "90th_percentile": 56.41, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 164.55, "10th_percentile": 161.33, "90th_percentile": 167.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 164.55, "10th_percentile": 161.33, "90th_percentile": 167.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fibrin degradation quant", "code_information": [ { "code": "85379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.00, "discounted_cash": 109.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 156.83, "10th_percentile": 156.83, "90th_percentile": 156.83, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 156.83, "10th_percentile": 156.83, "90th_percentile": 156.83, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 56.73, "10th_percentile": 51.32, "90th_percentile": 56.73, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 170.76, "10th_percentile": 111.64, "90th_percentile": 179.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.41, "10th_percentile": 133.41, "90th_percentile": 133.41, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "48", "median_amount": 53.80, "10th_percentile": 52.94, "90th_percentile": 54.34, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.73, "10th_percentile": 52.08, "90th_percentile": 56.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 55.60, "10th_percentile": 52.94, "90th_percentile": 55.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 103.96, "10th_percentile": 58.71, "90th_percentile": 149.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 103.96, "10th_percentile": 58.71, "90th_percentile": 149.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 49.78, "10th_percentile": 22.99, "90th_percentile": 56.41, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 164.55, "10th_percentile": 161.33, "90th_percentile": 167.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 164.55, "10th_percentile": 161.33, "90th_percentile": 167.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fibrinogen", "code_information": [ { "code": "85384", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 174.75, "discounted_cash": 104.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.34, "10th_percentile": 43.34, "90th_percentile": 43.34, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.17, "10th_percentile": 54.17, "90th_percentile": 54.17, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fibrinogen activity", "code_information": [ { "code": "85384", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 174.75, "discounted_cash": 104.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.34, "10th_percentile": 43.34, "90th_percentile": 43.34, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.17, "10th_percentile": 54.17, "90th_percentile": 54.17, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leukocyte alkaline phos", "code_information": [ { "code": "85540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.50, "discounted_cash": 92.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wbc alkaline phosphatase", "code_information": [ { "code": "85540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.50, "discounted_cash": 92.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lysozyme blood", "code_information": [ { "code": "85549", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 337.00, "discounted_cash": 202.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muramidase", "code_information": [ { "code": "85549", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 337.00, "discounted_cash": 202.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prothrombin time", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.25, "discounted_cash": 46.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 22.79, "10th_percentile": 22.79, "90th_percentile": 23.95, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.14, "10th_percentile": 22.50, "90th_percentile": 23.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "58", "median_amount": 3.57, "10th_percentile": 3.57, "90th_percentile": 73.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.87, "10th_percentile": 24.19, "90th_percentile": 75.70, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "187", "median_amount": 22.72, "10th_percentile": 22.31, "90th_percentile": 23.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.09, "10th_percentile": 17.87, "90th_percentile": 23.95, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "72", "median_amount": 23.48, "10th_percentile": 22.34, "90th_percentile": 23.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "52", "median_amount": 24.99, "10th_percentile": 20.09, "90th_percentile": 26.27, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "13", "median_amount": 23.48, "10th_percentile": 22.34, "90th_percentile": 70.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "13", "median_amount": 23.48, "10th_percentile": 22.34, "90th_percentile": 70.47, "methodology": "percent of total billed charges" } ] } ] }, { "description": "E s r (sed rate)", "code_information": [ { "code": "85652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.75, "discounted_cash": 29.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 35.10, "10th_percentile": 35.10, "90th_percentile": 35.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 35.10, "10th_percentile": 35.10, "90th_percentile": 35.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.72, "10th_percentile": 12.77, "90th_percentile": 15.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.55, "10th_percentile": 36.62, "90th_percentile": 47.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 14.34, "10th_percentile": 14.01, "90th_percentile": 14.81, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.11, "10th_percentile": 12.79, "90th_percentile": 15.11, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 14.81, "10th_percentile": 14.06, "90th_percentile": 14.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.61, "10th_percentile": 42.61, "90th_percentile": 42.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.61, "10th_percentile": 42.61, "90th_percentile": 42.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 13.26, "10th_percentile": 12.58, "90th_percentile": 16.58, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.93, "10th_percentile": 14.44, "90th_percentile": 42.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.93, "10th_percentile": 14.44, "90th_percentile": 42.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rbc sed rate automated", "code_information": [ { "code": "85652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.75, "discounted_cash": 29.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 35.10, "10th_percentile": 35.10, "90th_percentile": 35.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 35.10, "10th_percentile": 35.10, "90th_percentile": 35.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.72, "10th_percentile": 12.77, "90th_percentile": 15.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.55, "10th_percentile": 36.62, "90th_percentile": 47.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 14.34, "10th_percentile": 14.01, "90th_percentile": 14.81, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.11, "10th_percentile": 12.79, "90th_percentile": 15.11, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 14.81, "10th_percentile": 14.06, "90th_percentile": 14.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.61, "10th_percentile": 42.61, "90th_percentile": 42.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.61, "10th_percentile": 42.61, "90th_percentile": 42.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 13.26, "10th_percentile": 12.58, "90th_percentile": 16.58, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.93, "10th_percentile": 14.44, "90th_percentile": 42.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 35.93, "10th_percentile": 14.44, "90th_percentile": 42.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Thrombin time", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.75, "discounted_cash": 62.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thrombin time plasma", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.75, "discounted_cash": 62.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "P t t partial thromboplastin", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.25, "discounted_cash": 64.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.93, "10th_percentile": 31.93, "90th_percentile": 33.56, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.30, "10th_percentile": 31.30, "90th_percentile": 31.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.08, "10th_percentile": 93.37, "90th_percentile": 106.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.94, "10th_percentile": 100.94, "90th_percentile": 100.94, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 31.83, "10th_percentile": 31.29, "90th_percentile": 32.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.29, "10th_percentile": 25.03, "90th_percentile": 33.56, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 31.30, "10th_percentile": 31.30, "90th_percentile": 32.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 29.45, "10th_percentile": 28.02, "90th_percentile": 36.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 99.72, "10th_percentile": 96.33, "90th_percentile": 99.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 99.72, "10th_percentile": 96.33, "90th_percentile": 99.72, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Thromboplastin time partial", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.25, "discounted_cash": 64.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.93, "10th_percentile": 31.93, "90th_percentile": 33.56, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.30, "10th_percentile": 31.30, "90th_percentile": 31.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 106.08, "10th_percentile": 93.37, "90th_percentile": 106.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.94, "10th_percentile": 100.94, "90th_percentile": 100.94, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 31.83, "10th_percentile": 31.29, "90th_percentile": 32.89, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.29, "10th_percentile": 25.03, "90th_percentile": 33.56, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 31.30, "10th_percentile": 31.30, "90th_percentile": 32.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 29.45, "10th_percentile": 28.02, "90th_percentile": 36.81, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 99.72, "10th_percentile": 96.33, "90th_percentile": 99.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 99.72, "10th_percentile": 96.33, "90th_percentile": 99.72, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Allergen specific ige (rast)", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.75, "discounted_cash": 56.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 320.94, "10th_percentile": 152.73, "90th_percentile": 489.16, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.83, "10th_percentile": 84.83, "90th_percentile": 84.83, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.45, "10th_percentile": 27.34, "90th_percentile": 926.78, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1162.50, "10th_percentile": 1162.50, "90th_percentile": 1162.50, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.40, "10th_percentile": 16.86, "90th_percentile": 504.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 318.75, "10th_percentile": 318.75, "90th_percentile": 318.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Allg spec ige crude xtrc ea", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.75, "discounted_cash": 56.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 320.94, "10th_percentile": 152.73, "90th_percentile": 489.16, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.83, "10th_percentile": 84.83, "90th_percentile": 84.83, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.45, "10th_percentile": 27.34, "90th_percentile": 926.78, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1162.50, "10th_percentile": 1162.50, "90th_percentile": 1162.50, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.40, "10th_percentile": 16.86, "90th_percentile": 504.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 318.75, "10th_percentile": 318.75, "90th_percentile": 318.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Allg spec ige recomb ea", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.91, "10th_percentile": 24.91, "90th_percentile": 24.91, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.84, "10th_percentile": 24.84, "90th_percentile": 24.84, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alpha-gal ige panel", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.91, "10th_percentile": 24.91, "90th_percentile": 24.91, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.84, "10th_percentile": 24.84, "90th_percentile": 24.84, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelet antibodies", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 329.75, "discounted_cash": 197.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelet antibody direct", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 329.75, "discounted_cash": 197.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anti-jo-1", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.25, "discounted_cash": 193.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.43, "10th_percentile": 67.43, "90th_percentile": 67.43, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 202.86, "10th_percentile": 80.94, "90th_percentile": 213.15, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 63.41, "10th_percentile": 61.47, "90th_percentile": 65.44, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.43, "10th_percentile": 55.45, "90th_percentile": 67.43, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.09, "10th_percentile": 62.89, "90th_percentile": 66.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 152.55, "10th_percentile": 152.55, "90th_percentile": 152.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 152.55, "10th_percentile": 152.55, "90th_percentile": 152.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.16, "10th_percentile": 56.19, "90th_percentile": 84.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Antinuclear antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.25, "discounted_cash": 193.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.43, "10th_percentile": 67.43, "90th_percentile": 67.43, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 202.86, "10th_percentile": 80.94, "90th_percentile": 213.15, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 63.41, "10th_percentile": 61.47, "90th_percentile": 65.44, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.43, "10th_percentile": 55.45, "90th_percentile": 67.43, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.09, "10th_percentile": 62.89, "90th_percentile": 66.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 152.55, "10th_percentile": 152.55, "90th_percentile": 152.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 152.55, "10th_percentile": 152.55, "90th_percentile": 152.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.16, "10th_percentile": 56.19, "90th_percentile": 84.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "A s o titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 131.25, "discounted_cash": 78.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.69, "10th_percentile": 40.69, "90th_percentile": 40.69, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.48, "10th_percentile": 40.48, "90th_percentile": 40.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.12, "10th_percentile": 92.12, "90th_percentile": 92.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.12, "10th_percentile": 92.12, "90th_percentile": 92.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.09, "10th_percentile": 28.09, "90th_percentile": 28.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antistreptolysin o titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 131.25, "discounted_cash": 78.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.69, "10th_percentile": 40.69, "90th_percentile": 40.69, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.48, "10th_percentile": 40.48, "90th_percentile": 40.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.12, "10th_percentile": 92.12, "90th_percentile": 92.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.12, "10th_percentile": 92.12, "90th_percentile": 92.12, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.09, "10th_percentile": 28.09, "90th_percentile": 28.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C r p (c-reactive protein)", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.91, "10th_percentile": 28.91, "90th_percentile": 28.91, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.97, "10th_percentile": 43.91, "90th_percentile": 89.62, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "47", "median_amount": 27.42, "10th_percentile": 26.96, "90th_percentile": 28.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.91, "10th_percentile": 21.57, "90th_percentile": 28.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 28.34, "10th_percentile": 26.96, "90th_percentile": 28.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 73.59, "10th_percentile": 67.05, "90th_percentile": 80.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 73.59, "10th_percentile": 67.05, "90th_percentile": 80.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 25.37, "10th_percentile": 24.14, "90th_percentile": 31.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 68.72, "10th_percentile": 68.72, "90th_percentile": 79.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 68.72, "10th_percentile": 68.72, "90th_percentile": 79.15, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C-reactive protein", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.25, "discounted_cash": 55.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.91, "10th_percentile": 28.91, "90th_percentile": 28.91, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.97, "10th_percentile": 43.91, "90th_percentile": 89.62, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "47", "median_amount": 27.42, "10th_percentile": 26.96, "90th_percentile": 28.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.91, "10th_percentile": 21.57, "90th_percentile": 28.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 28.34, "10th_percentile": 26.96, "90th_percentile": 28.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 73.59, "10th_percentile": 67.05, "90th_percentile": 80.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 73.59, "10th_percentile": 67.05, "90th_percentile": 80.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 25.37, "10th_percentile": 24.14, "90th_percentile": 31.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 68.72, "10th_percentile": 68.72, "90th_percentile": 79.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 68.72, "10th_percentile": 68.72, "90th_percentile": 79.15, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C-reactive protein (hscrp)", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 139.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.78, "10th_percentile": 52.78, "90th_percentile": 52.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C-reactive protein hs", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 139.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.78, "10th_percentile": 52.78, "90th_percentile": 52.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aca igg", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 456.75, "discounted_cash": 274.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.97, "10th_percentile": 31.97, "90th_percentile": 31.97, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 242.56, "10th_percentile": 237.82, "90th_percentile": 247.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiolipin antibody ea ig", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 456.75, "discounted_cash": 274.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.97, "10th_percentile": 31.97, "90th_percentile": 31.97, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 242.56, "10th_percentile": 237.82, "90th_percentile": 247.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cold agglutinin titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cold agglutinin; titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement antigen", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 252.50, "discounted_cash": 151.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 191.78, "10th_percentile": 191.78, "90th_percentile": 191.78, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.44, "10th_percentile": 11.59, "90th_percentile": 65.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 189.31, "10th_percentile": 189.31, "90th_percentile": 189.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 189.31, "10th_percentile": 189.31, "90th_percentile": 189.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.50, "10th_percentile": 117.50, "90th_percentile": 117.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement c-3", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 252.50, "discounted_cash": 151.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 191.78, "10th_percentile": 191.78, "90th_percentile": 191.78, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.44, "10th_percentile": 11.59, "90th_percentile": 65.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 189.31, "10th_percentile": 189.31, "90th_percentile": 189.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 189.31, "10th_percentile": 189.31, "90th_percentile": 189.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.50, "10th_percentile": 117.50, "90th_percentile": 117.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C1 esterase inhibito", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement/function activity", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement total (ch50)", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 365.00, "discounted_cash": 219.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement; total hemolytic", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 365.00, "discounted_cash": 219.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anti-ccp ab igg + i", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.85, "10th_percentile": 41.85, "90th_percentile": 41.85, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ccp antibody", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.85, "10th_percentile": 41.85, "90th_percentile": 41.85, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anti dna (double stranded)", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.75, "discounted_cash": 148.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 27.62, "10th_percentile": 27.62, "90th_percentile": 27.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 27.62, "10th_percentile": 27.62, "90th_percentile": 27.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.12, "10th_percentile": 64.56, "90th_percentile": 67.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dna antibody native", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.75, "discounted_cash": 148.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 27.62, "10th_percentile": 27.62, "90th_percentile": 27.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 27.62, "10th_percentile": 27.62, "90th_percentile": 27.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.12, "10th_percentile": 64.56, "90th_percentile": 67.12, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anti dna (single stranded)", "code_information": [ { "code": "86226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.75, "discounted_cash": 130.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.23, "10th_percentile": 59.23, "90th_percentile": 59.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dna antibody single strand", "code_information": [ { "code": "86226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.75, "discounted_cash": 130.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.23, "10th_percentile": 59.23, "90th_percentile": 59.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anti-jo-1", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.25, "discounted_cash": 193.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 348.50, "10th_percentile": 136.45, "90th_percentile": 560.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nuclear antigen antibody", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.25, "discounted_cash": 193.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 348.50, "10th_percentile": 136.45, "90th_percentile": 560.56, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluorescent antibody titer", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.75, "discounted_cash": 130.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.85, "10th_percentile": 65.85, "90th_percentile": 65.85, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.96, "10th_percentile": 58.96, "90th_percentile": 58.96, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay nonantibody", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.75, "discounted_cash": 130.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.85, "10th_percentile": 65.85, "90th_percentile": 65.85, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.96, "10th_percentile": 58.96, "90th_percentile": 58.96, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay tumor anti (ca125)", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.75, "discounted_cash": 224.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 240.43, "10th_percentile": 153.87, "90th_percentile": 326.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.08, "10th_percentile": 108.08, "90th_percentile": 108.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay tumor ca 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.75, "discounted_cash": 224.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 240.43, "10th_percentile": 153.87, "90th_percentile": 326.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.08, "10th_percentile": 108.08, "90th_percentile": 108.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heterophile antibody titer", "code_information": [ { "code": "86309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.50, "discounted_cash": 79.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mono titer (heterophile ab)", "code_information": [ { "code": "86309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.50, "discounted_cash": 79.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heterophile antibody absrbj", "code_information": [ { "code": "86310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.50, "discounted_cash": 79.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mono titer (heterophile ab)", "code_information": [ { "code": "86310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.50, "discounted_cash": 79.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ia other tumor ag quan ea", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.75, "discounted_cash": 224.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay tumor other", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.75, "discounted_cash": 224.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "H pylori", "code_information": [ { "code": "86318", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.75, "discounted_cash": 194.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.67, "10th_percentile": 43.22, "90th_percentile": 100.67, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 208.45, "10th_percentile": 120.62, "90th_percentile": 296.29, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 274.78, "10th_percentile": 274.78, "90th_percentile": 274.78, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 93.95, "10th_percentile": 91.53, "90th_percentile": 97.72, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.66, "10th_percentile": 98.66, "90th_percentile": 98.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.12, "10th_percentile": 84.12, "90th_percentile": 87.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay infectious agent", "code_information": [ { "code": "86318", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.75, "discounted_cash": 194.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.67, "10th_percentile": 43.22, "90th_percentile": 100.67, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 208.45, "10th_percentile": 120.62, "90th_percentile": 296.29, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 274.78, "10th_percentile": 274.78, "90th_percentile": 274.78, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 93.95, "10th_percentile": 91.53, "90th_percentile": 97.72, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.66, "10th_percentile": 98.66, "90th_percentile": 98.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.12, "10th_percentile": 84.12, "90th_percentile": 87.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein immunoelectrophore", "code_information": [ { "code": "86320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 537.25, "discounted_cash": 322.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Serum immunoelectrophoresis", "code_information": [ { "code": "86320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 537.25, "discounted_cash": 322.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Other immunoelectrophoresis", "code_information": [ { "code": "86325", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 415.50, "discounted_cash": 249.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 120.16, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 120.16, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 125.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 113.02, "10th_percentile": 113.02, "90th_percentile": 113.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine immunoelectrophoresis", "code_information": [ { "code": "86325", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 415.50, "discounted_cash": 249.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 120.16, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 120.16, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 125.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 113.02, "10th_percentile": 113.02, "90th_percentile": 113.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement c-3", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 252.50, "discounted_cash": 151.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.72, "10th_percentile": 76.72, "90th_percentile": 76.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 221.32, "10th_percentile": 221.32, "90th_percentile": 221.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 221.32, "10th_percentile": 221.32, "90th_percentile": 221.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.68, "10th_percentile": 68.68, "90th_percentile": 68.68, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunodiffusion nes", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 252.50, "discounted_cash": 151.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.72, "10th_percentile": 76.72, "90th_percentile": 76.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 221.32, "10th_percentile": 221.32, "90th_percentile": 221.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 221.32, "10th_percentile": 221.32, "90th_percentile": 221.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.68, "10th_percentile": 68.68, "90th_percentile": 68.68, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunofix e-phoresis serum", "code_information": [ { "code": "86334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 401.25, "discounted_cash": 240.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.97, "10th_percentile": 117.97, "90th_percentile": 121.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.39, "10th_percentile": 124.39, "90th_percentile": 124.39, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.91, "10th_percentile": 121.91, "90th_percentile": 121.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Serum immunofixation electroph", "code_information": [ { "code": "86334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 401.25, "discounted_cash": 240.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.97, "10th_percentile": 117.97, "90th_percentile": 121.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 124.39, "10th_percentile": 124.39, "90th_percentile": 124.39, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.91, "10th_percentile": 121.91, "90th_percentile": 121.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insulin antibodies", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 384.50, "discounted_cash": 230.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insulin auto antibodies", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 384.50, "discounted_cash": 230.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intrinsic factor abs serum", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 162.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.33, "10th_percentile": 82.33, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intrinsic factor antibody", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 162.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.33, "10th_percentile": 82.33, "90th_percentile": 82.33, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ia-2 autoantibodies islet cell", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 423.25, "discounted_cash": 253.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Islet cell antibody", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 423.25, "discounted_cash": 253.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anti-microsomal ab", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 261.50, "discounted_cash": 156.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.88, "10th_percentile": 74.67, "90th_percentile": 77.91, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.07, "10th_percentile": 81.07, "90th_percentile": 81.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.65, "10th_percentile": 75.65, "90th_percentile": 142.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 150.07, "10th_percentile": 77.42, "90th_percentile": 222.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 150.07, "10th_percentile": 77.42, "90th_percentile": 222.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.13, "10th_percentile": 64.34, "90th_percentile": 78.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Microsomal antibody each", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 261.50, "discounted_cash": 156.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.88, "10th_percentile": 74.67, "90th_percentile": 77.91, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.07, "10th_percentile": 81.07, "90th_percentile": 81.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.65, "10th_percentile": 75.65, "90th_percentile": 142.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 150.07, "10th_percentile": 77.42, "90th_percentile": 222.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 150.07, "10th_percentile": 77.42, "90th_percentile": 222.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.13, "10th_percentile": 64.34, "90th_percentile": 78.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Particle agglut antbdy scrn", "code_information": [ { "code": "86403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rubella titer", "code_information": [ { "code": "86403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Qual rheum factor", "code_information": [ { "code": "86430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.25, "discounted_cash": 66.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.18, "10th_percentile": 34.18, "90th_percentile": 34.18, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.04, "10th_percentile": 108.04, "90th_percentile": 108.04, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 32.42, "10th_percentile": 30.97, "90th_percentile": 33.50, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.18, "10th_percentile": 28.12, "90th_percentile": 34.18, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.50, "10th_percentile": 32.54, "90th_percentile": 33.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 77.38, "10th_percentile": 77.38, "90th_percentile": 77.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 77.38, "10th_percentile": 77.38, "90th_percentile": 77.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.84, "10th_percentile": 29.99, "90th_percentile": 35.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.25, "10th_percentile": 81.25, "90th_percentile": 81.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.25, "10th_percentile": 81.25, "90th_percentile": 81.25, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rheumatoid factor test qual", "code_information": [ { "code": "86430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.25, "discounted_cash": 66.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.18, "10th_percentile": 34.18, "90th_percentile": 34.18, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.04, "10th_percentile": 108.04, "90th_percentile": 108.04, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 32.42, "10th_percentile": 30.97, "90th_percentile": 33.50, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.18, "10th_percentile": 28.12, "90th_percentile": 34.18, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.50, "10th_percentile": 32.54, "90th_percentile": 33.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 77.38, "10th_percentile": 77.38, "90th_percentile": 77.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 77.38, "10th_percentile": 77.38, "90th_percentile": 77.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.84, "10th_percentile": 29.99, "90th_percentile": 35.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.25, "10th_percentile": 81.25, "90th_percentile": 81.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 81.25, "10th_percentile": 81.25, "90th_percentile": 81.25, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Quantiferon b test cell immun", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1112.25, "discounted_cash": 667.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.63, "10th_percentile": 38.36, "90th_percentile": 213.44, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 337.91, "10th_percentile": 337.91, "90th_percentile": 337.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1024.60, "10th_percentile": 1024.60, "90th_percentile": 1024.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1024.60, "10th_percentile": 1024.60, "90th_percentile": 1024.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.94, "10th_percentile": 56.94, "90th_percentile": 56.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tb test cell immun measure", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1112.25, "discounted_cash": 667.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.63, "10th_percentile": 38.36, "90th_percentile": 213.44, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 337.91, "10th_percentile": 337.91, "90th_percentile": 337.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1024.60, "10th_percentile": 1024.60, "90th_percentile": 1024.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1024.60, "10th_percentile": 1024.60, "90th_percentile": 1024.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.94, "10th_percentile": 56.94, "90th_percentile": 56.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "minimum": 4.23, "maximum": 12.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.63, "10th_percentile": 22.63, "90th_percentile": 22.63, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.39, "count": "1 through 10", "median_amount": 54.41, "10th_percentile": 52.47, "90th_percentile": 56.35, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.18, "10th_percentile": 22.18, "90th_percentile": 22.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.46, "10th_percentile": 24.95, "90th_percentile": 25.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Syphilis test non-trep qual", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "minimum": 4.23, "maximum": 12.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.63, "10th_percentile": 22.63, "90th_percentile": 22.63, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.39, "count": "1 through 10", "median_amount": 54.41, "10th_percentile": 52.47, "90th_percentile": 56.35, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.18, "10th_percentile": 22.18, "90th_percentile": 22.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.46, "10th_percentile": 24.95, "90th_percentile": 25.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lyme disease antibody", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.25, "discounted_cash": 166.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lyme disease confirmatory", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.25, "discounted_cash": 166.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lyme disease ab screen", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 306.00, "discounted_cash": 183.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 157.59, "10th_percentile": 107.41, "90th_percentile": 207.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 157.59, "10th_percentile": 107.41, "90th_percentile": 207.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.86, "10th_percentile": 74.43, "90th_percentile": 94.86, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.97, "10th_percentile": 92.97, "90th_percentile": 92.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.96, "10th_percentile": 84.19, "90th_percentile": 285.42, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 89.96, "10th_percentile": 85.63, "90th_percentile": 92.96, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.86, "10th_percentile": 79.23, "90th_percentile": 94.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 92.97, "10th_percentile": 88.49, "90th_percentile": 92.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 220.07, "10th_percentile": 215.72, "90th_percentile": 224.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 220.07, "10th_percentile": 215.72, "90th_percentile": 224.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 79.22, "10th_percentile": 70.71, "90th_percentile": 91.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 253.70, "10th_percentile": 231.15, "90th_percentile": 276.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 253.70, "10th_percentile": 231.15, "90th_percentile": 276.26, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lyme disease antibody", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 306.00, "discounted_cash": 183.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 157.59, "10th_percentile": 107.41, "90th_percentile": 207.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 157.59, "10th_percentile": 107.41, "90th_percentile": 207.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.86, "10th_percentile": 74.43, "90th_percentile": 94.86, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.97, "10th_percentile": 92.97, "90th_percentile": 92.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.96, "10th_percentile": 84.19, "90th_percentile": 285.42, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 89.96, "10th_percentile": 85.63, "90th_percentile": 92.96, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.86, "10th_percentile": 79.23, "90th_percentile": 94.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 92.97, "10th_percentile": 88.49, "90th_percentile": 92.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 220.07, "10th_percentile": 215.72, "90th_percentile": 224.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 220.07, "10th_percentile": 215.72, "90th_percentile": 224.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 79.22, "10th_percentile": 70.71, "90th_percentile": 91.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 253.70, "10th_percentile": 231.15, "90th_percentile": 276.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 253.70, "10th_percentile": 231.15, "90th_percentile": 276.26, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chlamydia antibody", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 212.50, "discounted_cash": 127.50, "minimum": 11.70, "maximum": 34.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 34.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 34.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlamydia trachomatis", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 212.50, "discounted_cash": 127.50, "minimum": 11.70, "maximum": 34.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 34.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 34.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmv antibody", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytomeg virus-igg", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmv antibody igm", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.50, "10th_percentile": 87.50, "90th_percentile": 87.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytomeg virus-igm", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.50, "10th_percentile": 87.50, "90th_percentile": 87.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "California encephalitis ab", "code_information": [ { "code": "86651", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Encephalitis californ antbdy", "code_information": [ { "code": "86651", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eastern equine encephalitis ab", "code_information": [ { "code": "86652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 137.02, "10th_percentile": 137.02, "90th_percentile": 137.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Encephaltis east eqne anbdy", "code_information": [ { "code": "86652", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 137.02, "10th_percentile": 137.02, "90th_percentile": 137.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Encephaltis st louis antbody", "code_information": [ { "code": "86653", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 137.02, "10th_percentile": 137.02, "90th_percentile": 137.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "St louis encephalitis antibody", "code_information": [ { "code": "86653", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 137.02, "10th_percentile": 137.02, "90th_percentile": 137.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Encephaltis west eqne antbdy", "code_information": [ { "code": "86654", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Western equine encephalitis ab", "code_information": [ { "code": "86654", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "E b v early antigen", "code_information": [ { "code": "86663", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 235.75, "discounted_cash": 141.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epstein-barr antibody", "code_information": [ { "code": "86663", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 235.75, "discounted_cash": 141.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ebna antibody", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 274.75, "discounted_cash": 164.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.45, "10th_percentile": 79.45, "90th_percentile": 79.45, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.38, "10th_percentile": 31.12, "90th_percentile": 77.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 62.24, "10th_percentile": 62.24, "90th_percentile": 62.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 62.24, "10th_percentile": 62.24, "90th_percentile": 62.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.28, "10th_percentile": 73.36, "90th_percentile": 91.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epstein-barr nuclear antigen", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 274.75, "discounted_cash": 164.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.45, "10th_percentile": 79.45, "90th_percentile": 79.45, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.38, "10th_percentile": 31.12, "90th_percentile": 77.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 62.24, "10th_percentile": 62.24, "90th_percentile": 62.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 62.24, "10th_percentile": 62.24, "90th_percentile": 62.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.28, "10th_percentile": 73.36, "90th_percentile": 91.19, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eb vca igg", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 326.00, "discounted_cash": 195.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.51, "10th_percentile": 188.51, "90th_percentile": 188.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.17, "10th_percentile": 104.64, "90th_percentile": 187.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 147.68, "10th_percentile": 147.68, "90th_percentile": 147.68, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 147.68, "10th_percentile": 147.68, "90th_percentile": 147.68, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.23, "10th_percentile": 174.07, "90th_percentile": 216.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epstein-barr capsid vca", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 326.00, "discounted_cash": 195.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.51, "10th_percentile": 188.51, "90th_percentile": 188.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.17, "10th_percentile": 104.64, "90th_percentile": 187.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 147.68, "10th_percentile": 147.68, "90th_percentile": 147.68, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 147.68, "10th_percentile": 147.68, "90th_percentile": 147.68, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.23, "10th_percentile": 174.07, "90th_percentile": 216.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ehrlichia antibody", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.75, "discounted_cash": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.10, "10th_percentile": 72.10, "90th_percentile": 72.10, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tick-borne disease a", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.75, "discounted_cash": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.10, "10th_percentile": 72.10, "90th_percentile": 72.10, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Helicobacter pylori (stool)", "code_information": [ { "code": "86677", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.90, "10th_percentile": 91.90, "90th_percentile": 91.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.90, "10th_percentile": 89.52, "90th_percentile": 91.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.84, "10th_percentile": 92.09, "90th_percentile": 93.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 244.87, "10th_percentile": 244.87, "90th_percentile": 244.87, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 244.87, "10th_percentile": 244.87, "90th_percentile": 244.87, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Helicobacter pylori antibody", "code_information": [ { "code": "86677", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.90, "10th_percentile": 91.90, "90th_percentile": 91.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.90, "10th_percentile": 89.52, "90th_percentile": 91.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.84, "10th_percentile": 92.09, "90th_percentile": 93.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 244.87, "10th_percentile": 244.87, "90th_percentile": 244.87, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 244.87, "10th_percentile": 244.87, "90th_percentile": 244.87, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Herpes simplex type 1 test", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.00, "discounted_cash": 79.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hsv 1 ab igg", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.00, "discounted_cash": 79.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Herpes simplex type 2 test", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hsv 2 ab igg", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hiv i and ii antibody", "code_information": [ { "code": "86703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.25, "discounted_cash": 147.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.34, "10th_percentile": 76.34, "90th_percentile": 76.34, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.83, "10th_percentile": 71.37, "90th_percentile": 72.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.73, "10th_percentile": 80.13, "90th_percentile": 83.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hiv-1/hiv-2 1 result antbdy", "code_information": [ { "code": "86703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.25, "discounted_cash": 147.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.34, "10th_percentile": 76.34, "90th_percentile": 76.34, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.83, "10th_percentile": 71.37, "90th_percentile": 72.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.73, "10th_percentile": 80.13, "90th_percentile": 83.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 226.85, "10th_percentile": 226.85, "90th_percentile": 226.85, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ab; hbcab - total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.75, "discounted_cash": 130.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 212.41, "10th_percentile": 212.41, "90th_percentile": 212.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.02, "10th_percentile": 6.02, "90th_percentile": 6.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 199.67, "10th_percentile": 199.67, "90th_percentile": 199.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 199.67, "10th_percentile": 199.67, "90th_percentile": 199.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hep b core antibody total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.75, "discounted_cash": 130.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 212.41, "10th_percentile": 212.41, "90th_percentile": 212.41, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.02, "10th_percentile": 6.02, "90th_percentile": 6.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 199.67, "10th_percentile": 199.67, "90th_percentile": 199.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 199.67, "10th_percentile": 199.67, "90th_percentile": 199.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hep b surface antibody", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 177.79, "10th_percentile": 177.79, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 177.79, "10th_percentile": 177.79, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.50, "10th_percentile": 52.50, "90th_percentile": 52.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis b surface antibody", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 115.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 177.79, "10th_percentile": 177.79, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 177.79, "10th_percentile": 177.79, "90th_percentile": 177.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.50, "10th_percentile": 52.50, "90th_percentile": 52.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis be antibody", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 124.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis be antibody (hbeab)", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 124.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haab total", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 222.75, "discounted_cash": 133.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 135.35, "10th_percentile": 135.35, "90th_percentile": 135.35, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.41, "10th_percentile": 64.41, "90th_percentile": 64.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis a antibody", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 222.75, "discounted_cash": 133.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 135.35, "10th_percentile": 135.35, "90th_percentile": 135.35, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.41, "10th_percentile": 64.41, "90th_percentile": 64.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Legionella antibody", "code_information": [ { "code": "86713", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 165.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.52, "10th_percentile": 79.52, "90th_percentile": 79.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Legionella igg", "code_information": [ { "code": "86713", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 165.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 79.52, "10th_percentile": 79.52, "90th_percentile": 79.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mumps antibody", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 234.50, "discounted_cash": 140.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mumps virus antibody", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 234.50, "discounted_cash": 140.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycoplasma antibody", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.00, "discounted_cash": 142.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.82, "10th_percentile": 68.82, "90th_percentile": 68.82, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycoplasma igm", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.00, "discounted_cash": 142.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 68.82, "10th_percentile": 68.82, "90th_percentile": 68.82, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Parvovirus antibody", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Parvovirus b19 huma", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protozoa antibody nos", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tick-borne disease a", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rickettsia antibody", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.48, "10th_percentile": 100.48, "90th_percentile": 100.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 200.97, "10th_percentile": 200.97, "90th_percentile": 200.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.93, "10th_percentile": 179.93, "90th_percentile": 179.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rocky mt spotted fever igg", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 100.48, "10th_percentile": 100.48, "90th_percentile": 100.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 200.97, "10th_percentile": 200.97, "90th_percentile": 200.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 179.93, "10th_percentile": 179.93, "90th_percentile": 179.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rubella antibody", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rubella titer", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rubeola antibody", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.50, "discounted_cash": 138.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rubeola igg antibody", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.50, "discounted_cash": 138.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Igg sars-cov-2 covid-19 ab", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 756.50, "discounted_cash": 453.90, "minimum": 41.71, "maximum": 122.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 122.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 122.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sars-cov-2 covid-19 antibody", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 756.50, "discounted_cash": 453.90, "minimum": 41.71, "maximum": 122.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 122.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 122.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Igm sars-cov-2 covid-19 ab", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 756.50, "discounted_cash": 453.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "59", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxoplasma antibody", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toxoplasmosis", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "F t a", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.00, "discounted_cash": 142.80, "minimum": 13.11, "maximum": 38.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 38.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 38.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 219.25, "10th_percentile": 219.25, "90th_percentile": 219.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 219.25, "10th_percentile": 219.25, "90th_percentile": 219.25, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Treponema pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.00, "discounted_cash": 142.80, "minimum": 13.11, "maximum": 38.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 38.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 38.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 219.25, "10th_percentile": 219.25, "90th_percentile": 219.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 219.25, "10th_percentile": 219.25, "90th_percentile": 219.25, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Varicella zoster titer", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.50, "discounted_cash": 138.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Varicella-zoster antibody", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 231.50, "discounted_cash": 138.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "West nile virus ab igm", "code_information": [ { "code": "86788", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.50, "10th_percentile": 87.50, "90th_percentile": 87.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "West nile virus igm", "code_information": [ { "code": "86788", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.50, "10th_percentile": 87.50, "90th_percentile": 87.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "West nile virus antibody", "code_information": [ { "code": "86789", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.74, "10th_percentile": 74.74, "90th_percentile": 74.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "West nile virus igg", "code_information": [ { "code": "86789", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.74, "10th_percentile": 74.74, "90th_percentile": 74.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Virus antibody nos", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "West nile virus igm", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.50, "discounted_cash": 181.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anti-thyroglobulin ab", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 285.75, "discounted_cash": 171.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.63, "10th_percentile": 80.50, "90th_percentile": 82.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.72, "10th_percentile": 83.06, "90th_percentile": 86.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 64.74, "10th_percentile": 64.74, "90th_percentile": 64.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 64.74, "10th_percentile": 64.74, "90th_percentile": 64.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.73, "10th_percentile": 75.11, "90th_percentile": 91.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroglobulin antibody", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 285.75, "discounted_cash": 171.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.63, "10th_percentile": 80.50, "90th_percentile": 82.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.72, "10th_percentile": 83.06, "90th_percentile": 86.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 64.74, "10th_percentile": 64.74, "90th_percentile": 64.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 64.74, "10th_percentile": 64.74, "90th_percentile": 64.74, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.73, "10th_percentile": 75.11, "90th_percentile": 91.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis c ab test", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 256.25, "discounted_cash": 153.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.54, "10th_percentile": 63.08, "90th_percentile": 79.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 77.85, "10th_percentile": 74.13, "90th_percentile": 251.12, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 251.12, "10th_percentile": 251.12, "90th_percentile": 251.12, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 75.34, "10th_percentile": 72.22, "90th_percentile": 77.85, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.13, "10th_percentile": 74.13, "90th_percentile": 74.13, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.86, "10th_percentile": 74.13, "90th_percentile": 183.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 161.59, "10th_percentile": 102.02, "90th_percentile": 221.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 161.59, "10th_percentile": 102.02, "90th_percentile": 221.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.13, "10th_percentile": 83.79, "90th_percentile": 87.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 236.06, "10th_percentile": 236.06, "90th_percentile": 236.06, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 236.06, "10th_percentile": 236.06, "90th_percentile": 236.06, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hepatitis c virus ab", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 256.25, "discounted_cash": 153.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.54, "10th_percentile": 63.08, "90th_percentile": 79.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 77.85, "10th_percentile": 74.13, "90th_percentile": 251.12, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 251.12, "10th_percentile": 251.12, "90th_percentile": 251.12, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 75.34, "10th_percentile": 72.22, "90th_percentile": 77.85, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.13, "10th_percentile": 74.13, "90th_percentile": 74.13, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.86, "10th_percentile": 74.13, "90th_percentile": 183.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 161.59, "10th_percentile": 102.02, "90th_percentile": 221.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 161.59, "10th_percentile": 102.02, "90th_percentile": 221.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.13, "10th_percentile": 83.79, "90th_percentile": 87.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 236.06, "10th_percentile": 236.06, "90th_percentile": 236.06, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 236.06, "10th_percentile": 236.06, "90th_percentile": 236.06, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hla typing a b or c", "code_information": [ { "code": "86812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 463.75, "discounted_cash": 278.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hla-b27", "code_information": [ { "code": "86812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 463.75, "discounted_cash": 278.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antibody screen", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 88.20, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.57, "10th_percentile": 36.46, "90th_percentile": 45.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "1 through 10", "median_amount": 116.03, "10th_percentile": 105.88, "90th_percentile": 119.10, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 144.06, "10th_percentile": 137.20, "90th_percentile": 144.06, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 43.22, "10th_percentile": 42.53, "90th_percentile": 44.66, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "1 through 10", "median_amount": 42.97, "10th_percentile": 42.97, "90th_percentile": 44.47, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.57, "10th_percentile": 36.34, "90th_percentile": 45.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 42.54, "10th_percentile": 42.54, "90th_percentile": 44.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 135.42, "10th_percentile": 135.42, "90th_percentile": 135.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 135.42, "10th_percentile": 135.42, "90th_percentile": 135.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.03, "10th_percentile": 21.67, "90th_percentile": 39.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc antibody screen", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 88.20, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.57, "10th_percentile": 36.46, "90th_percentile": 45.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "1 through 10", "median_amount": 116.03, "10th_percentile": 105.88, "90th_percentile": 119.10, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 144.06, "10th_percentile": 137.20, "90th_percentile": 144.06, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 43.22, "10th_percentile": 42.53, "90th_percentile": 44.66, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "1 through 10", "median_amount": 42.97, "10th_percentile": 42.97, "90th_percentile": 44.47, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.57, "10th_percentile": 36.34, "90th_percentile": 45.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 42.54, "10th_percentile": 42.54, "90th_percentile": 44.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 135.42, "10th_percentile": 135.42, "90th_percentile": 135.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 135.42, "10th_percentile": 135.42, "90th_percentile": 135.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.03, "10th_percentile": 21.67, "90th_percentile": 39.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antibody id", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 861.50, "discounted_cash": 516.90, "minimum": 319.97, "maximum": 938.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 319.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc antibody identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 861.50, "discounted_cash": 516.90, "minimum": 319.97, "maximum": 938.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 319.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Coombs test direct", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1020.50, "discounted_cash": 612.30, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Copper level", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1020.50, "discounted_cash": 612.30, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Autologous blood col & storage", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 441.00, "discounted_cash": 264.60, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Autologous blood process", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 441.00, "discounted_cash": 264.60, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abo typing", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 240.30, "10th_percentile": 240.30, "90th_percentile": 240.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 240.30, "10th_percentile": 240.30, "90th_percentile": 240.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.46, "10th_percentile": 85.39, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 263.45, "10th_percentile": 219.89, "90th_percentile": 276.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 32.53, "10th_percentile": 30.88, "90th_percentile": 293.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 98.13, "10th_percentile": 96.53, "90th_percentile": 101.39, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 97.52, "10th_percentile": 93.96, "90th_percentile": 97.52, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.46, "10th_percentile": 82.47, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 96.53, "10th_percentile": 96.53, "90th_percentile": 101.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 307.45, "10th_percentile": 307.45, "90th_percentile": 307.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 307.45, "10th_percentile": 307.45, "90th_percentile": 307.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.78, "10th_percentile": 87.30, "90th_percentile": 90.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 292.71, "10th_percentile": 292.71, "90th_percentile": 292.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 292.71, "10th_percentile": 292.71, "90th_percentile": 292.71, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Blood typing serologic abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 240.30, "10th_percentile": 240.30, "90th_percentile": 240.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 240.30, "10th_percentile": 240.30, "90th_percentile": 240.30, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.46, "10th_percentile": 85.39, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 263.45, "10th_percentile": 219.89, "90th_percentile": 276.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 32.53, "10th_percentile": 30.88, "90th_percentile": 293.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 98.13, "10th_percentile": 96.53, "90th_percentile": 101.39, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 97.52, "10th_percentile": 93.96, "90th_percentile": 97.52, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 103.46, "10th_percentile": 82.47, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 96.53, "10th_percentile": 96.53, "90th_percentile": 101.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 307.45, "10th_percentile": 307.45, "90th_percentile": 307.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 307.45, "10th_percentile": 307.45, "90th_percentile": 307.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.78, "10th_percentile": 87.30, "90th_percentile": 90.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 292.71, "10th_percentile": 292.71, "90th_percentile": 292.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 292.71, "10th_percentile": 292.71, "90th_percentile": 292.71, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Blood typing serologic rh(d)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 72.36, "10th_percentile": 72.36, "90th_percentile": 72.36, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 72.36, "10th_percentile": 72.36, "90th_percentile": 72.36, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.16, "10th_percentile": 25.69, "90th_percentile": 31.16, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "1 through 10", "median_amount": 80.35, "10th_percentile": 73.83, "90th_percentile": 84.66, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.04, "10th_percentile": 94.08, "90th_percentile": 98.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 29.55, "10th_percentile": 29.02, "90th_percentile": 30.54, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "1 through 10", "median_amount": 29.31, "10th_percentile": 29.31, "90th_percentile": 30.38, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.16, "10th_percentile": 26.15, "90th_percentile": 31.16, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 29.02, "10th_percentile": 29.02, "90th_percentile": 30.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 92.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 92.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.34, "10th_percentile": 26.25, "90th_percentile": 27.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 87.97, "10th_percentile": 87.97, "90th_percentile": 87.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 87.97, "10th_percentile": 87.97, "90th_percentile": 87.97, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rbc antigens (du)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 72.36, "10th_percentile": 72.36, "90th_percentile": 72.36, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 72.36, "10th_percentile": 72.36, "90th_percentile": 72.36, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.16, "10th_percentile": 25.69, "90th_percentile": 31.16, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "1 through 10", "median_amount": 80.35, "10th_percentile": 73.83, "90th_percentile": 84.66, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.04, "10th_percentile": 94.08, "90th_percentile": 98.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 29.55, "10th_percentile": 29.02, "90th_percentile": 30.54, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "1 through 10", "median_amount": 29.31, "10th_percentile": 29.31, "90th_percentile": 30.38, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.16, "10th_percentile": 26.15, "90th_percentile": 31.16, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 29.02, "10th_percentile": 29.02, "90th_percentile": 30.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 92.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 92.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.34, "10th_percentile": 26.25, "90th_percentile": 27.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 87.97, "10th_percentile": 87.97, "90th_percentile": 87.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 87.97, "10th_percentile": 87.97, "90th_percentile": 87.97, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Blood typing rbc antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "minimum": 319.97, "maximum": 938.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 319.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc antigens (du)", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "minimum": 319.97, "maximum": 938.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 319.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Compatibility test antiglob", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 441.00, "discounted_cash": 264.60, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 410.13, "10th_percentile": 410.13, "90th_percentile": 410.13, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "1 through 10", "median_amount": 418.13, "10th_percentile": 348.85, "90th_percentile": 487.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 627.69, "10th_percentile": 471.28, "90th_percentile": 784.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 45.28, "10th_percentile": 43.22, "90th_percentile": 94.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "1 through 10", "median_amount": 257.80, "10th_percentile": 257.80, "90th_percentile": 257.80, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 323.55, "10th_percentile": 174.08, "90th_percentile": 473.01, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.98, "10th_percentile": 130.15, "90th_percentile": 214.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 609.37, "10th_percentile": 446.87, "90th_percentile": 771.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 609.37, "10th_percentile": 446.87, "90th_percentile": 771.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Crossmatch", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 441.00, "discounted_cash": 264.60, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 410.13, "10th_percentile": 410.13, "90th_percentile": 410.13, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "1 through 10", "median_amount": 418.13, "10th_percentile": 348.85, "90th_percentile": 487.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 627.69, "10th_percentile": 471.28, "90th_percentile": 784.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 45.28, "10th_percentile": 43.22, "90th_percentile": 94.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "1 through 10", "median_amount": 257.80, "10th_percentile": 257.80, "90th_percentile": 257.80, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 323.55, "10th_percentile": 174.08, "90th_percentile": 473.01, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.98, "10th_percentile": 130.15, "90th_percentile": 214.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 609.37, "10th_percentile": 446.87, "90th_percentile": 771.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 609.37, "10th_percentile": 446.87, "90th_percentile": 771.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ff plasma thawing each unit", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 441.00, "discounted_cash": 264.60, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "1 through 10", "median_amount": 515.59, "10th_percentile": 515.59, "90th_percentile": 515.59, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Plasma fresh frozen", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 441.00, "discounted_cash": 264.60, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "1 through 10", "median_amount": 515.59, "10th_percentile": 515.59, "90th_percentile": 515.59, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood culture for bacteria", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.50, "discounted_cash": 111.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 115.01, "10th_percentile": 115.01, "90th_percentile": 115.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 115.01, "10th_percentile": 115.01, "90th_percentile": 115.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 109.43, "10th_percentile": 87.54, "90th_percentile": 115.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 345.94, "10th_percentile": 178.08, "90th_percentile": 363.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 363.58, "10th_percentile": 363.58, "90th_percentile": 363.58, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "94", "median_amount": 109.07, "10th_percentile": 107.24, "90th_percentile": 112.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 107.24, "10th_percentile": 85.79, "90th_percentile": 114.78, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "51", "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 112.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 120.02, "10th_percentile": 65.60, "90th_percentile": 126.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 341.77, "10th_percentile": 261.43, "90th_percentile": 341.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 341.77, "10th_percentile": 261.43, "90th_percentile": 341.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Culture blood", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.50, "discounted_cash": 111.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 115.01, "10th_percentile": 115.01, "90th_percentile": 115.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 115.01, "10th_percentile": 115.01, "90th_percentile": 115.01, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 109.43, "10th_percentile": 87.54, "90th_percentile": 115.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 345.94, "10th_percentile": 178.08, "90th_percentile": 363.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 363.58, "10th_percentile": 363.58, "90th_percentile": 363.58, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "94", "median_amount": 109.07, "10th_percentile": 107.24, "90th_percentile": 112.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 107.24, "10th_percentile": 85.79, "90th_percentile": 114.78, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "51", "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 112.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 120.02, "10th_percentile": 65.60, "90th_percentile": 126.14, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 341.77, "10th_percentile": 261.43, "90th_percentile": 341.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 341.77, "10th_percentile": 261.43, "90th_percentile": 341.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Culture stool s/s", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.75, "discounted_cash": 101.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Feces culture aerobic bact", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.75, "discounted_cash": 101.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture stool enteric", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.75, "discounted_cash": 101.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Stool cultr aerobic bact ea", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.75, "discounted_cash": 101.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bacterial culture - othr sourc", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.25, "discounted_cash": 93.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.33, "10th_percentile": 121.01, "90th_percentile": 131.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.33, "10th_percentile": 121.01, "90th_percentile": 131.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.13, "10th_percentile": 38.43, "90th_percentile": 48.13, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.13, "10th_percentile": 48.13, "90th_percentile": 48.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 111.81, "10th_percentile": 33.83, "90th_percentile": 152.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 144.79, "10th_percentile": 144.79, "90th_percentile": 144.79, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 45.65, "10th_percentile": 44.88, "90th_percentile": 47.17, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.17, "10th_percentile": 47.17, "90th_percentile": 47.94, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 44.89, "10th_percentile": 44.89, "90th_percentile": 47.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.21, "10th_percentile": 36.42, "90th_percentile": 44.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 136.11, "10th_percentile": 136.11, "90th_percentile": 136.11, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 136.11, "10th_percentile": 136.11, "90th_percentile": 136.11, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Culture othr specimn aerobic", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.25, "discounted_cash": 93.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.33, "10th_percentile": 121.01, "90th_percentile": 131.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.33, "10th_percentile": 121.01, "90th_percentile": 131.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.13, "10th_percentile": 38.43, "90th_percentile": 48.13, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.13, "10th_percentile": 48.13, "90th_percentile": 48.13, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 111.81, "10th_percentile": 33.83, "90th_percentile": 152.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 144.79, "10th_percentile": 144.79, "90th_percentile": 144.79, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 45.65, "10th_percentile": 44.88, "90th_percentile": 47.17, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.17, "10th_percentile": 47.17, "90th_percentile": 47.94, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 44.89, "10th_percentile": 44.89, "90th_percentile": 47.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.21, "10th_percentile": 36.42, "90th_percentile": 44.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 136.11, "10th_percentile": 136.11, "90th_percentile": 136.11, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 136.11, "10th_percentile": 136.11, "90th_percentile": 136.11, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Anaerobic culture id", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.25, "discounted_cash": 102.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 137.91, "10th_percentile": 137.91, "90th_percentile": 137.91, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 137.91, "10th_percentile": 137.91, "90th_percentile": 137.91, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.46, "10th_percentile": 107.46, "90th_percentile": 107.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.06, "10th_percentile": 50.06, "90th_percentile": 50.06, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.22, "10th_percentile": 49.22, "90th_percentile": 49.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cultr bacteria except blood", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.25, "discounted_cash": 102.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 137.91, "10th_percentile": 137.91, "90th_percentile": 137.91, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 137.91, "10th_percentile": 137.91, "90th_percentile": 137.91, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.46, "10th_percentile": 107.46, "90th_percentile": 107.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.06, "10th_percentile": 50.06, "90th_percentile": 50.06, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.22, "10th_percentile": 49.22, "90th_percentile": 49.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bc - aerobic - addtl id", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.25, "discounted_cash": 102.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 109.81, "90th_percentile": 125.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 109.81, "90th_percentile": 125.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 42.86, "10th_percentile": 34.29, "90th_percentile": 66.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.01, "10th_percentile": 42.01, "90th_percentile": 42.01, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 129.05, "10th_percentile": 95.94, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 142.34, "10th_percentile": 130.84, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "187", "median_amount": 42.71, "10th_percentile": 42.00, "90th_percentile": 84.01, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 45.03, "10th_percentile": 42.00, "90th_percentile": 76.21, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "78", "median_amount": 44.13, "10th_percentile": 42.01, "90th_percentile": 88.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 39.51, "10th_percentile": 39.51, "90th_percentile": 39.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 39.51, "10th_percentile": 39.51, "90th_percentile": 39.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 39.51, "10th_percentile": 34.24, "90th_percentile": 84.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture aerobic identify", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.25, "discounted_cash": 102.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 109.81, "90th_percentile": 125.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 109.81, "90th_percentile": 125.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 42.86, "10th_percentile": 34.29, "90th_percentile": 66.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.01, "10th_percentile": 42.01, "90th_percentile": 42.01, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 129.05, "10th_percentile": 95.94, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 142.34, "10th_percentile": 130.84, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "187", "median_amount": 42.71, "10th_percentile": 42.00, "90th_percentile": 84.01, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 45.03, "10th_percentile": 42.00, "90th_percentile": 76.21, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "78", "median_amount": 44.13, "10th_percentile": 42.01, "90th_percentile": 88.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 39.51, "10th_percentile": 39.51, "90th_percentile": 39.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 39.51, "10th_percentile": 39.51, "90th_percentile": 39.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 39.51, "10th_percentile": 34.24, "90th_percentile": 84.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture p pathog screen", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.25, "discounted_cash": 71.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 107.33, "10th_percentile": 107.33, "90th_percentile": 107.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 107.33, "10th_percentile": 107.33, "90th_percentile": 107.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.49, "10th_percentile": 34.49, "90th_percentile": 34.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.93, "10th_percentile": 1.93, "90th_percentile": 1.93, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.93, "10th_percentile": 1.93, "90th_percentile": 1.93, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.87, "10th_percentile": 21.99, "90th_percentile": 32.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 109.85, "10th_percentile": 109.85, "90th_percentile": 109.85, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 109.85, "10th_percentile": 109.85, "90th_percentile": 109.85, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Culture screen only", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.25, "discounted_cash": 71.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 107.33, "10th_percentile": 107.33, "90th_percentile": 107.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 107.33, "10th_percentile": 107.33, "90th_percentile": 107.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.49, "10th_percentile": 34.49, "90th_percentile": 34.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.93, "10th_percentile": 1.93, "90th_percentile": 1.93, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.93, "10th_percentile": 1.93, "90th_percentile": 1.93, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.87, "10th_percentile": 21.99, "90th_percentile": 32.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 109.85, "10th_percentile": 109.85, "90th_percentile": 109.85, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 109.85, "10th_percentile": 109.85, "90th_percentile": 109.85, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Culture urine", "code_information": [ { "code": "87086", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.25, "discounted_cash": 87.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 104.58, "90th_percentile": 130.73, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 104.58, "90th_percentile": 130.73, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "64", "median_amount": 42.86, "10th_percentile": 34.29, "90th_percentile": 45.03, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.01, "10th_percentile": 42.01, "90th_percentile": 42.01, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 44.13, "10th_percentile": 5.42, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.52, "10th_percentile": 4.42, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "248", "median_amount": 42.71, "10th_percentile": 42.00, "90th_percentile": 44.13, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 44.13, "10th_percentile": 40.66, "90th_percentile": 45.03, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "107", "median_amount": 44.13, "10th_percentile": 42.01, "90th_percentile": 44.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 133.80, "10th_percentile": 58.37, "90th_percentile": 133.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 133.80, "10th_percentile": 58.37, "90th_percentile": 133.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 39.51, "10th_percentile": 34.57, "90th_percentile": 60.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.20, "10th_percentile": 109.07, "90th_percentile": 125.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.20, "10th_percentile": 109.07, "90th_percentile": 125.33, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Urine culture/colony count", "code_information": [ { "code": "87086", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.25, "discounted_cash": 87.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 104.58, "90th_percentile": 130.73, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 117.66, "10th_percentile": 104.58, "90th_percentile": 130.73, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "64", "median_amount": 42.86, "10th_percentile": 34.29, "90th_percentile": 45.03, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.01, "10th_percentile": 42.01, "90th_percentile": 42.01, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 44.13, "10th_percentile": 5.42, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.52, "10th_percentile": 4.42, "90th_percentile": 142.34, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "248", "median_amount": 42.71, "10th_percentile": 42.00, "90th_percentile": 44.13, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 44.13, "10th_percentile": 40.66, "90th_percentile": 45.03, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "107", "median_amount": 44.13, "10th_percentile": 42.01, "90th_percentile": 44.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 133.80, "10th_percentile": 58.37, "90th_percentile": 133.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 133.80, "10th_percentile": 58.37, "90th_percentile": 133.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 39.51, "10th_percentile": 34.57, "90th_percentile": 60.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.20, "10th_percentile": 109.07, "90th_percentile": 125.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.20, "10th_percentile": 109.07, "90th_percentile": 125.33, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Culture fungus skin hair nail", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 138.75, "discounted_cash": 83.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin fungi culture", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 138.75, "discounted_cash": 83.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture fungus (not blood)", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 151.25, "discounted_cash": 90.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fungus isolation culture", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 151.25, "discounted_cash": 90.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood fungus culture", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 367.25, "discounted_cash": 220.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fungal culture blood", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 367.25, "discounted_cash": 220.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlamydia culture", "code_information": [ { "code": "87110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 351.75, "discounted_cash": 211.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture acid fast", "code_information": [ { "code": "87118", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.50, "discounted_cash": 157.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycobacteric identification", "code_information": [ { "code": "87118", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 262.50, "discounted_cash": 157.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture type immunofluoresc", "code_information": [ { "code": "87140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture viral", "code_information": [ { "code": "87140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pinworm exam", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scotch tape test/pinworm", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Giardia ag by if", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.61, "10th_percentile": 48.61, "90th_percentile": 48.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ova and parasites smears", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.61, "10th_percentile": 48.61, "90th_percentile": 48.61, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Microbe susceptible mic", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.75, "discounted_cash": 93.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.16, "10th_percentile": 119.15, "90th_percentile": 140.18, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.16, "10th_percentile": 119.15, "90th_percentile": 140.18, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 48.28, "10th_percentile": 36.77, "90th_percentile": 77.26, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.05, "10th_percentile": 45.05, "90th_percentile": 45.05, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 152.63, "10th_percentile": 85.76, "90th_percentile": 162.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.36, "10th_percentile": 76.55, "90th_percentile": 144.18, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "180", "median_amount": 45.80, "10th_percentile": 45.04, "90th_percentile": 90.08, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 48.28, "10th_percentile": 45.04, "90th_percentile": 77.54, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "74", "median_amount": 47.32, "10th_percentile": 45.05, "90th_percentile": 94.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 42.37, "10th_percentile": 37.07, "90th_percentile": 93.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sensitivity", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.75, "discounted_cash": 93.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.16, "10th_percentile": 119.15, "90th_percentile": 140.18, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 126.16, "10th_percentile": 119.15, "90th_percentile": 140.18, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "41", "median_amount": 48.28, "10th_percentile": 36.77, "90th_percentile": 77.26, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.05, "10th_percentile": 45.05, "90th_percentile": 45.05, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 152.63, "10th_percentile": 85.76, "90th_percentile": 162.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.36, "10th_percentile": 76.55, "90th_percentile": 144.18, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "180", "median_amount": 45.80, "10th_percentile": 45.04, "90th_percentile": 90.08, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 48.28, "10th_percentile": 45.04, "90th_percentile": 77.54, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "74", "median_amount": 47.32, "10th_percentile": 45.05, "90th_percentile": 94.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 42.37, "10th_percentile": 37.07, "90th_percentile": 93.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gram stain study", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 62.17, "10th_percentile": 62.17, "90th_percentile": 62.17, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 62.17, "10th_percentile": 62.17, "90th_percentile": 62.17, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.21, "10th_percentile": 20.83, "90th_percentile": 23.79, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.13, "10th_percentile": 72.59, "90th_percentile": 75.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 22.57, "10th_percentile": 22.11, "90th_percentile": 23.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 22.18, "10th_percentile": 22.18, "90th_percentile": 23.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.82, "10th_percentile": 17.46, "90th_percentile": 18.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.25, "10th_percentile": 67.25, "90th_percentile": 67.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.25, "10th_percentile": 67.25, "90th_percentile": 67.25, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Smear gram stain", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 62.17, "10th_percentile": 62.17, "90th_percentile": 62.17, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 62.17, "10th_percentile": 62.17, "90th_percentile": 62.17, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.21, "10th_percentile": 20.83, "90th_percentile": 23.79, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.13, "10th_percentile": 72.59, "90th_percentile": 75.57, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 22.57, "10th_percentile": 22.11, "90th_percentile": 23.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 22.18, "10th_percentile": 22.18, "90th_percentile": 23.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.82, "10th_percentile": 17.46, "90th_percentile": 18.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.25, "10th_percentile": 67.25, "90th_percentile": 67.25, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.25, "10th_percentile": 67.25, "90th_percentile": 67.25, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acid fast bacilli smear", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 97.00, "discounted_cash": 58.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Smear fluorescent/acid stai", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 97.00, "discounted_cash": 58.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Malarial thick/thin smear", "code_information": [ { "code": "87207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 107.75, "discounted_cash": 64.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Smear special stain", "code_information": [ { "code": "87207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 107.75, "discounted_cash": 64.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "India ink study", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.50, "discounted_cash": 62.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Smear wet mount saline/ink", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.50, "discounted_cash": 62.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "K o h prep", "code_information": [ { "code": "87220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam for fungi", "code_information": [ { "code": "87220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay toxin or antitoxin", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 354.75, "discounted_cash": 212.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.97, "10th_percentile": 92.38, "90th_percentile": 109.97, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.61, "10th_percentile": 102.61, "90th_percentile": 102.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 313.67, "10th_percentile": 105.71, "90th_percentile": 347.65, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 104.30, "10th_percentile": 102.61, "90th_percentile": 104.30, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.61, "10th_percentile": 102.61, "90th_percentile": 106.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.19, "10th_percentile": 102.61, "90th_percentile": 107.78, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.62, "10th_percentile": 103.74, "90th_percentile": 120.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 287.17, "10th_percentile": 287.17, "90th_percentile": 287.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 287.17, "10th_percentile": 287.17, "90th_percentile": 287.17, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Clostridium difficile", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 354.75, "discounted_cash": 212.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.97, "10th_percentile": 92.38, "90th_percentile": 109.97, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.61, "10th_percentile": 102.61, "90th_percentile": 102.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 313.67, "10th_percentile": 105.71, "90th_percentile": 347.65, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 104.30, "10th_percentile": 102.61, "90th_percentile": 104.30, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.61, "10th_percentile": 102.61, "90th_percentile": 106.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.19, "10th_percentile": 102.61, "90th_percentile": 107.78, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.62, "10th_percentile": 103.74, "90th_percentile": 120.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 287.17, "10th_percentile": 287.17, "90th_percentile": 287.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 287.17, "10th_percentile": 287.17, "90th_percentile": 287.17, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Adenovirus culture", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.25, "discounted_cash": 280.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Virus inoculation tissue", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.25, "discounted_cash": 280.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Giardia ag by if", "code_information": [ { "code": "87269", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Giardia ag if", "code_information": [ { "code": "87269", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlamydia trachomatis ag if", "code_information": [ { "code": "87270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 215.00, "discounted_cash": 129.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlamydia trachomatis dfa", "code_information": [ { "code": "87270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 215.00, "discounted_cash": 129.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cryptosporidium ag if", "code_information": [ { "code": "87272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 620.75, "discounted_cash": 372.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cryptospirdium", "code_information": [ { "code": "87272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 620.75, "discounted_cash": 372.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respiratory syncytial ag if", "code_information": [ { "code": "87280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 144.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rsv stain", "code_information": [ { "code": "87280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 144.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cryptosporidium ag ia", "code_information": [ { "code": "87328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 248.25, "discounted_cash": 148.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyptosporidium exam", "code_information": [ { "code": "87328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 248.25, "discounted_cash": 148.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hbsag", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.75, "discounted_cash": 111.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 171.11, "10th_percentile": 171.11, "90th_percentile": 171.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 171.11, "10th_percentile": 171.11, "90th_percentile": 171.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.53, "10th_percentile": 50.53, "90th_percentile": 50.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis b surface ag ia", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.75, "discounted_cash": 111.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 171.11, "10th_percentile": 171.11, "90th_percentile": 171.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 171.11, "10th_percentile": 171.11, "90th_percentile": 171.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.53, "10th_percentile": 50.53, "90th_percentile": 50.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rotavirus ag ia", "code_information": [ { "code": "87425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 215.00, "discounted_cash": 129.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rotavirus antigen", "code_information": [ { "code": "87425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 215.00, "discounted_cash": 129.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sarscov coronavirus ag ia", "code_information": [ { "code": "87426", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.25, "discounted_cash": 128.55, "minimum": 34.98, "maximum": 102.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.09, "10th_percentile": 65.09, "90th_percentile": 65.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.09, "10th_percentile": 61.98, "90th_percentile": 65.09, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.42, "10th_percentile": 66.42, "90th_percentile": 66.42, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.10, "10th_percentile": 65.10, "90th_percentile": 65.10, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strep a ag ia", "code_information": [ { "code": "87430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.00, "discounted_cash": 181.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.79, "10th_percentile": 88.79, "90th_percentile": 88.79, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.55, "10th_percentile": 87.79, "90th_percentile": 91.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.14, "10th_percentile": 73.93, "90th_percentile": 94.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strep group a (10 minute)", "code_information": [ { "code": "87430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.00, "discounted_cash": 181.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.79, "10th_percentile": 88.79, "90th_percentile": 88.79, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.55, "10th_percentile": 87.79, "90th_percentile": 91.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.14, "10th_percentile": 73.93, "90th_percentile": 94.63, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ag detect nos ia mult", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.25, "discounted_cash": 34.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.75, "10th_percentile": 8.75, "90th_percentile": 16.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 34.79, "10th_percentile": 33.45, "90th_percentile": 100.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.79, "10th_percentile": 34.79, "90th_percentile": 34.79, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 16.84, "10th_percentile": 16.68, "90th_percentile": 16.95, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 17.40, "10th_percentile": 17.40, "90th_percentile": 17.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Waived inf agent antigen detec", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.25, "discounted_cash": 34.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "QW", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.75, "10th_percentile": 15.97, "90th_percentile": 26.63, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 17.39, "10th_percentile": 16.64, "90th_percentile": 36.33, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 16.84, "10th_percentile": 16.24, "90th_percentile": 17.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.56, "10th_percentile": 16.56, "90th_percentile": 17.51, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.40, "10th_percentile": 17.40, "90th_percentile": 17.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Candida - direct probe", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 360.25, "discounted_cash": 216.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Candida dna dir probe", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 360.25, "discounted_cash": 216.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlamydophila pneumonia pcr", "code_information": [ { "code": "87486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chylmd pneum dna amp probe", "code_information": [ { "code": "87486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlamydia nat", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.28, "10th_percentile": 182.28, "90th_percentile": 182.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 209.10, "10th_percentile": 70.72, "90th_percentile": 214.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chylmd trach dna amp probe", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.28, "10th_percentile": 182.28, "90th_percentile": 182.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 209.10, "10th_percentile": 70.72, "90th_percentile": 214.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cytomeg dna quant", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 769.00, "discounted_cash": 461.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.00, "10th_percentile": 61.00, "90th_percentile": 61.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.55, "10th_percentile": 35.55, "90th_percentile": 134.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 39.78, "10th_percentile": 37.39, "90th_percentile": 261.46, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Infect agent det by nucleic ac", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 769.00, "discounted_cash": 461.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.00, "10th_percentile": 61.00, "90th_percentile": 61.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.55, "10th_percentile": 35.55, "90th_percentile": 134.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 39.78, "10th_percentile": 37.39, "90th_percentile": 261.46, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nfct agent detection gi", "code_information": [ { "code": "87505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 677.75, "discounted_cash": 406.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 230.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nfct agent dna/rna gi 3-5 targ", "code_information": [ { "code": "87505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 677.75, "discounted_cash": 406.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 230.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gardner vag dna dir probe", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 360.25, "discounted_cash": 216.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gardnerella vaginalis - dp", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 360.25, "discounted_cash": 216.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hbv quant pcr rfx to", "code_information": [ { "code": "87517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 642.00, "discounted_cash": 385.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis b dna quant", "code_information": [ { "code": "87517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 642.00, "discounted_cash": 385.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hcv rna by pcr qn r", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 642.00, "discounted_cash": 385.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.86, "10th_percentile": 52.86, "90th_percentile": 52.86, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hepatitis c revrs trnscrpj", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 642.00, "discounted_cash": 385.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.86, "10th_percentile": 52.86, "90th_percentile": 52.86, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "M.pneumon dna amp probe", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycoplasma pneumonia pcr", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gonorrhoeae nat", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.28, "10th_percentile": 182.28, "90th_percentile": 182.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 204.00, "10th_percentile": 132.68, "90th_percentile": 214.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" } ] } ] }, { "description": "N.gonorrhoeae dna amp prob", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 182.28, "10th_percentile": 182.28, "90th_percentile": 182.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 204.00, "10th_percentile": 132.68, "90th_percentile": 214.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 580.36, "10th_percentile": 580.36, "90th_percentile": 580.36, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mpox dna pcr", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 307.80, "minimum": 50.80, "maximum": 148.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 50.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orthopoxvirus amp prb each", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 307.80, "minimum": 50.80, "maximum": 148.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 50.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resp virus 3-5 targets", "code_information": [ { "code": "87631", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.50, "discounted_cash": 375.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respiratory virus 3-5 targets", "code_information": [ { "code": "87631", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.50, "discounted_cash": 375.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resp virus 12-25 targets", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.50, "discounted_cash": 375.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respiratory virus 3-5 targets", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.50, "discounted_cash": 375.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Covid-19 pcr non-cdc test", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 440.00, "discounted_cash": 264.00, "minimum": 50.80, "maximum": 148.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 50.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 113.97, "10th_percentile": 113.97, "90th_percentile": 113.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sars-cov-2 covid-19 amp prb", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 440.00, "discounted_cash": 264.00, "minimum": 50.80, "maximum": 148.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 148.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 50.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 113.97, "10th_percentile": 113.97, "90th_percentile": 113.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respiratory virus 3-5 targets", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.50, "discounted_cash": 375.30, "minimum": 141.20, "maximum": 414.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 506.65, "10th_percentile": 193.91, "90th_percentile": 562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 506.65, "10th_percentile": 193.91, "90th_percentile": 562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "81", "median_amount": 184.61, "10th_percentile": 147.69, "90th_percentile": 193.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 414.00, "count": "249", "median_amount": 428.72, "10th_percentile": 285.03, "90th_percentile": 526.25, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 414.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "133", "median_amount": 190.03, "10th_percentile": 180.92, "90th_percentile": 583.59, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 190.03, "10th_percentile": 185.47, "90th_percentile": 321.75, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "299", "median_amount": 183.90, "10th_percentile": 180.92, "90th_percentile": 190.03, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 141.20, "count": "48", "median_amount": 182.76, "10th_percentile": 182.52, "90th_percentile": 191.97, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 190.03, "10th_percentile": 180.92, "90th_percentile": 193.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "116", "median_amount": 190.04, "10th_percentile": 180.92, "90th_percentile": 190.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "20", "median_amount": 170.14, "10th_percentile": 161.98, "90th_percentile": 469.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "20", "median_amount": 170.14, "10th_percentile": 161.98, "90th_percentile": 469.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 170.14, "10th_percentile": 38.61, "90th_percentile": 202.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "16", "median_amount": 576.21, "10th_percentile": 102.49, "90th_percentile": 576.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "16", "median_amount": 576.21, "10th_percentile": 102.49, "90th_percentile": 576.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sarscov2&inf a&b&rsv amp prb", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.50, "discounted_cash": 375.30, "minimum": 141.20, "maximum": 414.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 506.65, "10th_percentile": 193.91, "90th_percentile": 562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "11", "median_amount": 506.65, "10th_percentile": 193.91, "90th_percentile": 562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "81", "median_amount": 184.61, "10th_percentile": 147.69, "90th_percentile": 193.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 414.00, "count": "249", "median_amount": 428.72, "10th_percentile": 285.03, "90th_percentile": 526.25, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 414.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "133", "median_amount": 190.03, "10th_percentile": 180.92, "90th_percentile": 583.59, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 190.03, "10th_percentile": 185.47, "90th_percentile": 321.75, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "299", "median_amount": 183.90, "10th_percentile": 180.92, "90th_percentile": 190.03, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 141.20, "count": "48", "median_amount": 182.76, "10th_percentile": 182.52, "90th_percentile": 191.97, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 190.03, "10th_percentile": 180.92, "90th_percentile": 193.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "116", "median_amount": 190.04, "10th_percentile": 180.92, "90th_percentile": 190.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "20", "median_amount": 170.14, "10th_percentile": 161.98, "90th_percentile": 469.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "20", "median_amount": 170.14, "10th_percentile": 161.98, "90th_percentile": 469.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 170.14, "10th_percentile": 38.61, "90th_percentile": 202.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "16", "median_amount": 576.21, "10th_percentile": 102.49, "90th_percentile": 576.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "16", "median_amount": 576.21, "10th_percentile": 102.49, "90th_percentile": 576.21, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Trichomonas - direct probe", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trichomonas vaginalis amplif", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bordetella pertussis pcr", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Detect agent nos dna amp", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 378.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bk quantitation pcr", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 769.00, "discounted_cash": 461.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 163.20, "10th_percentile": 83.30, "90th_percentile": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Detect agent nos dna quant", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 769.00, "discounted_cash": 461.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 163.20, "10th_percentile": 83.30, "90th_percentile": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay w dir oo influenza", "code_information": [ { "code": "87804", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 297.25, "discounted_cash": 178.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Influenza assay w/optic", "code_information": [ { "code": "87804", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 297.25, "discounted_cash": 178.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rsv", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 235.25, "discounted_cash": 141.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rsv assay w/optic", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 235.25, "discounted_cash": 141.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Waived rsv immunoassay", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.25, "discounted_cash": 34.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "QW", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Genotype dna/rna hep c", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 800.00, "discounted_cash": 480.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis g genotype", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 800.00, "discounted_cash": 480.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath fl nongyn smears", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 620.75, "discounted_cash": 372.45, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.21, "10th_percentile": 38.21, "90th_percentile": 38.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.59, "10th_percentile": 188.59, "90th_percentile": 188.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath fl nongyn smears", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 230.75, "discounted_cash": 138.45, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath fl nongyn smears", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 620.75, "discounted_cash": 372.45, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 173.19, "10th_percentile": 157.79, "90th_percentile": 188.58, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 236.96, "10th_percentile": 236.96, "90th_percentile": 236.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.84, "10th_percentile": 60.84, "90th_percentile": 60.84, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "1 through 10", "median_amount": 181.38, "10th_percentile": 181.38, "90th_percentile": 181.38, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.59, "10th_percentile": 188.59, "90th_percentile": 188.59, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.45, "10th_percentile": 57.07, "90th_percentile": 67.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath c/v thin layer redo", "code_information": [ { "code": "88143", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 413.50, "discounted_cash": 248.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 122.06, "10th_percentile": 122.06, "90th_percentile": 122.06, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.62, "10th_percentile": 119.62, "90th_percentile": 119.62, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.60, "10th_percentile": 121.98, "90th_percentile": 125.22, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 239.25, "10th_percentile": 239.25, "90th_percentile": 239.25, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.63, "10th_percentile": 125.63, "90th_percentile": 125.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.88, "10th_percentile": 109.25, "90th_percentile": 140.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pap dx thin prep", "code_information": [ { "code": "88143", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 413.50, "discounted_cash": 248.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 318.94, "10th_percentile": 318.94, "90th_percentile": 318.94, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 122.06, "10th_percentile": 122.06, "90th_percentile": 122.06, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.62, "10th_percentile": 119.62, "90th_percentile": 119.62, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.60, "10th_percentile": 121.98, "90th_percentile": 125.22, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 239.25, "10th_percentile": 239.25, "90th_percentile": 239.25, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.63, "10th_percentile": 125.63, "90th_percentile": 125.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.88, "10th_percentile": 109.25, "90th_percentile": 140.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath eval fna report", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 546.60, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 285.65, "10th_percentile": 285.65, "90th_percentile": 285.65, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eval of fna; int & rep", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 506.25, "discounted_cash": 303.75, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eval of fna; int & rep", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 546.60, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 312.15, "10th_percentile": 119.06, "90th_percentile": 505.25, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 276.77, "10th_percentile": 276.77, "90th_percentile": 276.77, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surgical path gross", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 453.25, "discounted_cash": 271.95, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pathology pro level 1", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53.25, "discounted_cash": 31.95, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Level i pathology", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 453.25, "discounted_cash": 271.95, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "1 through 10", "median_amount": 357.80, "10th_percentile": 357.80, "90th_percentile": 357.80, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.88, "10th_percentile": 107.88, "90th_percentile": 107.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 453.25, "discounted_cash": 271.95, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pathology pro level 2", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Level 2 pathology", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 453.25, "discounted_cash": 271.95, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "1 through 10", "median_amount": 572.03, "10th_percentile": 419.49, "90th_percentile": 724.56, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 546.60, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 268.93, "10th_percentile": 268.93, "90th_percentile": 268.93, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "1 through 10", "median_amount": 651.52, "10th_percentile": 651.52, "90th_percentile": 651.52, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.28, "10th_percentile": 9.10, "90th_percentile": 93.52, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pathology pro level 3", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 131.75, "discounted_cash": 79.05, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Level 3 pathology", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 546.60, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 275.67, "10th_percentile": 270.28, "90th_percentile": 281.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "18", "median_amount": 724.50, "10th_percentile": 617.25, "90th_percentile": 766.49, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "1 through 10", "median_amount": 583.91, "10th_percentile": 583.91, "90th_percentile": 583.91, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 527.10, "10th_percentile": 527.10, "90th_percentile": 527.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 476.81, "10th_percentile": 316.77, "90th_percentile": 809.59, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "1 through 10", "median_amount": 256.24, "10th_percentile": 256.24, "90th_percentile": 256.24, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 263.56, "10th_percentile": 263.56, "90th_percentile": 274.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 247.79, "10th_percentile": 118.00, "90th_percentile": 421.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 546.60, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 564.82, "10th_percentile": 338.89, "90th_percentile": 790.75, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "1 through 10", "median_amount": 654.12, "10th_percentile": 632.85, "90th_percentile": 1055.32, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 276.76, "10th_percentile": 276.76, "90th_percentile": 276.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "39", "median_amount": 178.56, "10th_percentile": 85.01, "90th_percentile": 540.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "1 through 10", "median_amount": 279.59, "10th_percentile": 268.91, "90th_percentile": 279.59, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1997.85, "10th_percentile": 1038.88, "90th_percentile": 2956.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1997.85, "10th_percentile": 1038.88, "90th_percentile": 2956.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pathology pro level 4", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.75, "discounted_cash": 50.25, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Level 4 pathology", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 546.60, "minimum": 47.53, "maximum": 139.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 819.90, "10th_percentile": 819.90, "90th_percentile": 819.90, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 819.90, "10th_percentile": 819.90, "90th_percentile": 819.90, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 564.82, "10th_percentile": 225.93, "90th_percentile": 1581.50, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.34, "count": "42", "median_amount": 1532.96, "10th_percentile": 660.69, "90th_percentile": 2993.74, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 263.56, "10th_percentile": 263.56, "90th_percentile": 263.56, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 276.76, "10th_percentile": 263.55, "90th_percentile": 2015.29, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.53, "count": "12", "median_amount": 545.83, "10th_percentile": 279.59, "90th_percentile": 1894.39, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 540.31, "10th_percentile": 263.55, "90th_percentile": 836.81, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 553.53, "10th_percentile": 263.56, "90th_percentile": 1897.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 619.48, "10th_percentile": 294.95, "90th_percentile": 1327.28, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1678.42, "10th_percentile": 1007.05, "90th_percentile": 2349.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1678.42, "10th_percentile": 1007.05, "90th_percentile": 2349.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5337.50, "discounted_cash": 3202.50, "minimum": 319.97, "maximum": 938.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 319.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pathology pro level 5", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 872.00, "discounted_cash": 523.20, "minimum": 319.97, "maximum": 938.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 319.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Level 5 pathology", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5337.50, "discounted_cash": 3202.50, "minimum": 319.97, "maximum": 938.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 938.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 319.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1621.54, "10th_percentile": 1621.54, "90th_percentile": 1621.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1608.62, "10th_percentile": 1608.62, "90th_percentile": 1608.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12009.50, "discounted_cash": 7205.70, "minimum": 726.64, "maximum": 2130.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2130.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2130.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 726.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pathology pro level 6", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.25, "discounted_cash": 193.35, "minimum": 726.64, "maximum": 2130.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2130.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2130.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 726.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Level 6 pathology", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12009.50, "discounted_cash": 7205.70, "minimum": 726.64, "maximum": 2130.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2130.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2130.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 726.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Special stains group 2", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 620.75, "discounted_cash": 372.45, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cryptospirdium", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 620.75, "discounted_cash": 372.45, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.91, "10th_percentile": 66.91, "90th_percentile": 66.91, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 181.38, "10th_percentile": 181.38, "90th_percentile": 181.38, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunohisto antb 1st stain", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2733.50, "discounted_cash": 1640.10, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunohisto antibody slide", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.50, "discounted_cash": 47.10, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunohisto antibody 1st stain", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2733.50, "discounted_cash": 1640.10, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Body fluid cell count", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.25, "discounted_cash": 51.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.54, "10th_percentile": 83.54, "90th_percentile": 83.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.91, "10th_percentile": 25.91, "90th_percentile": 25.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 74.62, "10th_percentile": 74.62, "90th_percentile": 74.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 74.62, "10th_percentile": 74.62, "90th_percentile": 74.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cell count spinal", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.25, "discounted_cash": 51.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.54, "10th_percentile": 83.54, "90th_percentile": 83.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.91, "10th_percentile": 25.91, "90th_percentile": 25.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 74.62, "10th_percentile": 74.62, "90th_percentile": 74.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 74.62, "10th_percentile": 74.62, "90th_percentile": 74.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Leukocyte assessment fecal", "code_information": [ { "code": "89055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.21, "10th_percentile": 75.21, "90th_percentile": 75.21, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.57, "10th_percentile": 22.30, "90th_percentile": 22.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.18, "10th_percentile": 22.18, "90th_percentile": 22.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.10, "10th_percentile": 26.10, "90th_percentile": 26.10, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leukocyte count fecal", "code_information": [ { "code": "89055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.75, "discounted_cash": 46.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.21, "10th_percentile": 75.21, "90th_percentile": 75.21, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.57, "10th_percentile": 22.30, "90th_percentile": 22.57, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.18, "10th_percentile": 22.18, "90th_percentile": 22.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.10, "10th_percentile": 26.10, "90th_percentile": 26.10, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Crystals bile", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.00, "discounted_cash": 79.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 115.60, "10th_percentile": 115.60, "90th_percentile": 115.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 115.60, "10th_percentile": 115.60, "90th_percentile": 115.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Exam synovial fluid crystals", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.00, "discounted_cash": 79.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 115.60, "10th_percentile": 115.60, "90th_percentile": 115.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 115.60, "10th_percentile": 115.60, "90th_percentile": 115.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nasal smear for eos", "code_information": [ { "code": "89190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nasal smear for eosinophils", "code_information": [ { "code": "89190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sputum collected by aerosol", "code_information": [ { "code": "89220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2733.50, "discounted_cash": 1640.10, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sputum specimen collection", "code_information": [ { "code": "89220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2733.50, "discounted_cash": 1640.10, "minimum": 152.43, "maximum": 446.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 446.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 152.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Semen analysis w/count", "code_information": [ { "code": "89310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sperm count", "code_information": [ { "code": "89310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Semen anal vol/count/mot", "code_information": [ { "code": "89320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 221.50, "discounted_cash": 132.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Semen complete analysis", "code_information": [ { "code": "89320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 221.50, "discounted_cash": 132.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rabies immune globulin inj", "drug_information": { "unit": 300.00, "type": "F2" }, "code_information": [ { "code": "90375", "type": "CPT" }, { "code": "76125015002a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1650.00, "discounted_cash": 990.00, "minimum": 287.01, "maximum": 841.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 841.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 841.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 287.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine beyfotus rsv 50mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "90380", "type": "CPT" }, { "code": "49281057515", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5713.00, "discounted_cash": 3427.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine beyfotus rsv 100mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "90381", "type": "CPT" }, { "code": "49281057488", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5713.00, "discounted_cash": 3427.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunization admin", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.51, "10th_percentile": 6.51, "90th_percentile": 6.90, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "11", "median_amount": 17.67, "10th_percentile": 17.57, "90th_percentile": 18.84, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 17.67, "10th_percentile": 17.67, "90th_percentile": 17.67, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 2.19, "10th_percentile": 1.47, "90th_percentile": 2.26, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.90, "10th_percentile": 6.48, "90th_percentile": 6.90, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.02, "10th_percentile": 18.02, "90th_percentile": 18.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.57, "10th_percentile": 7.36, "90th_percentile": 7.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 19.35, "10th_percentile": 19.35, "90th_percentile": 19.35, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 19.35, "10th_percentile": 19.35, "90th_percentile": 19.35, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vaccine adm influenza", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.51, "10th_percentile": 6.51, "90th_percentile": 6.90, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "11", "median_amount": 17.67, "10th_percentile": 17.57, "90th_percentile": 18.84, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 17.67, "10th_percentile": 17.67, "90th_percentile": 17.67, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 2.19, "10th_percentile": 1.47, "90th_percentile": 2.26, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.90, "10th_percentile": 6.48, "90th_percentile": 6.90, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.02, "10th_percentile": 18.02, "90th_percentile": 18.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.57, "10th_percentile": 7.36, "90th_percentile": 7.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 19.35, "10th_percentile": 19.35, "90th_percentile": 19.35, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 19.35, "10th_percentile": 19.35, "90th_percentile": 19.35, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Immunization admin each add", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.57, "10th_percentile": 7.57, "90th_percentile": 7.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine adm ea addl single com", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.57, "10th_percentile": 7.57, "90th_percentile": 7.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immune admin oral/nasal", "code_information": [ { "code": "90473", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine adm oral nasal", "code_information": [ { "code": "90473", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adm moderna vac 2nd", "code_information": [ { "code": "90480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 36.93, "maximum": 108.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 108.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 108.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 36.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Admn sarscov2 vacc 1 dose", "code_information": [ { "code": "90480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 36.93, "maximum": 108.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 108.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 108.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 36.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine menb-4c 2 dose sch", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90620", "type": "CPT" }, { "code": "58160097620A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2405.00, "discounted_cash": 1443.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis a vaccine adult", "drug_information": { "unit": 1440.00, "type": "UN" }, "code_information": [ { "code": "90632", "type": "CPT" }, { "code": "58160082652a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 307.00, "discounted_cash": 184.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis a vaccine adult", "drug_information": { "unit": 1440.00, "type": "UN" }, "code_information": [ { "code": "90632", "type": "CPT" }, { "code": "58160082652b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine vaxneuvance pneumpcv15", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90671", "type": "CPT" }, { "code": "00006432903a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2303.00, "discounted_cash": 1381.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine rabies inj", "drug_information": { "unit": 2.50, "type": "F2" }, "code_information": [ { "code": "90675", "type": "CPT" }, { "code": "50632001001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 943.00, "discounted_cash": 565.80, "minimum": 314.49, "maximum": 922.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 922.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 922.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 314.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prevnar 20 vaccine", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90677", "type": "CPT" }, { "code": "00005200001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2867.00, "discounted_cash": 1720.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine mmr", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90707", "type": "CPT" }, { "code": "00006468100", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 919.00, "discounted_cash": 551.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine td np >= 7 yr im", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90714", "type": "CPT" }, { "code": "49281021515A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 426.00, "discounted_cash": 255.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine adacel 0.5 ml inj", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90715", "type": "CPT" }, { "code": "49281040010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 469.00, "discounted_cash": 281.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine dtap hepb ipv 0.5 ml", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90723", "type": "CPT" }, { "code": "58160081152", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1032.00, "discounted_cash": 619.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Speech/hearing therapy", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 301.25, "discounted_cash": 180.75, "minimum": 70.24, "maximum": 205.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 205.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 205.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 70.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.53, "10th_percentile": 91.53, "90th_percentile": 91.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of speech", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 301.25, "discounted_cash": 180.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.53, "10th_percentile": 91.53, "90th_percentile": 91.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Speech/hearing therapy", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.50, "discounted_cash": 47.10, "minimum": 21.76, "maximum": 63.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp treatment group", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.50, "discounted_cash": 47.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluation of speech fluency", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 446.25, "discounted_cash": 267.75, "minimum": 122.18, "maximum": 358.21, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 358.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 358.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 122.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluation of speech fluency", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 446.25, "discounted_cash": 267.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluate speech production", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.25, "discounted_cash": 225.75, "minimum": 102.14, "maximum": 299.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 299.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 299.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 102.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluate speech production", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.25, "discounted_cash": 225.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.62, "10th_percentile": 38.62, "90th_percentile": 38.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.31, "10th_percentile": 114.31, "90th_percentile": 114.31, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Speech sound lang comprehen", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 509.75, "discounted_cash": 305.85, "minimum": 209.22, "maximum": 613.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 613.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 613.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 209.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Speech sound lang compreh", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 509.75, "discounted_cash": 305.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Behavral qualit analys voice", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 371.00, "discounted_cash": 222.60, "minimum": 100.34, "maximum": 294.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 294.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 294.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 100.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Behavral qualit analys voice", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 371.00, "discounted_cash": 222.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oral function therapy", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.25, "discounted_cash": 194.55, "minimum": 77.04, "maximum": 225.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.42, "10th_percentile": 80.42, "90th_percentile": 80.42, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 225.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 225.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 77.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.04, "10th_percentile": 75.04, "90th_percentile": 75.04, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.51, "10th_percentile": 98.51, "90th_percentile": 98.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of swallowing", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.25, "discounted_cash": 194.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.82, "10th_percentile": 57.82, "90th_percentile": 57.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.04, "10th_percentile": 75.04, "90th_percentile": 75.04, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.61, "10th_percentile": 44.61, "90th_percentile": 44.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluate swallowing function", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "minimum": 65.14, "maximum": 190.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 190.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 190.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 65.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluation of swallowing", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.10, "10th_percentile": 82.44, "90th_percentile": 85.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.33, "10th_percentile": 55.89, "90th_percentile": 104.05, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.05, "10th_percentile": 33.40, "90th_percentile": 35.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 160.78, "10th_percentile": 160.78, "90th_percentile": 160.78, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 105.58, "10th_percentile": 105.58, "90th_percentile": 105.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiopulmonary resuscitation", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1017.25, "discounted_cash": 610.35, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 685.00, "10th_percentile": 590.76, "90th_percentile": 879.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 309.04, "10th_percentile": 309.04, "90th_percentile": 309.04, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 240.43, "10th_percentile": 185.53, "90th_percentile": 295.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heart/lung resuscitation cpr", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1017.25, "discounted_cash": 610.35, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 685.00, "10th_percentile": 590.76, "90th_percentile": 879.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 309.04, "10th_percentile": 309.04, "90th_percentile": 309.04, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 240.43, "10th_percentile": 185.53, "90th_percentile": 295.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pacemaker external temp", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2159.00, "discounted_cash": 1295.40, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Temporary external pacing", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2159.00, "discounted_cash": 1295.40, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardioversion elective", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2159.00, "discounted_cash": 1295.40, "minimum": 582.08, "maximum": 1706.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1706.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1706.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 216.61, "10th_percentile": 212.59, "90th_percentile": 220.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 582.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 655.90, "10th_percentile": 655.90, "90th_percentile": 655.90, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 655.91, "10th_percentile": 655.91, "90th_percentile": 655.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardioversion electric ext", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2159.00, "discounted_cash": 1295.40, "minimum": 582.08, "maximum": 1706.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1706.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1706.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 216.61, "10th_percentile": 212.59, "90th_percentile": 220.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 582.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 655.90, "10th_percentile": 655.90, "90th_percentile": 655.90, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 655.91, "10th_percentile": 655.91, "90th_percentile": 655.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ekg tracing only", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 249.25, "discounted_cash": 149.55, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 224.33, "10th_percentile": 109.17, "90th_percentile": 224.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 224.33, "10th_percentile": 109.17, "90th_percentile": 224.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "210", "median_amount": 73.55, "10th_percentile": 58.84, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "175", "median_amount": 196.75, "10th_percentile": 148.54, "90th_percentile": 210.55, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "1 through 10", "median_amount": 169.66, "10th_percentile": 169.66, "90th_percentile": 169.66, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.37, "10th_percentile": 48.95, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "157", "median_amount": 72.08, "10th_percentile": 57.66, "90th_percentile": 75.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.72, "10th_percentile": 21.65, "90th_percentile": 97.05, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "507", "median_amount": 25.58, "10th_percentile": 24.41, "90th_percentile": 26.87, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "152", "median_amount": 72.81, "10th_percentile": 69.25, "90th_percentile": 76.50, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "94", "median_amount": 72.08, "10th_percentile": 27.27, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "423", "median_amount": 72.08, "10th_percentile": 45.44, "90th_percentile": 75.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.55, "10th_percentile": 183.69, "90th_percentile": 229.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.55, "10th_percentile": 183.69, "90th_percentile": 229.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 67.80, "10th_percentile": 59.33, "90th_percentile": 84.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "19", "median_amount": 229.61, "10th_percentile": 202.06, "90th_percentile": 229.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "19", "median_amount": 229.61, "10th_percentile": 202.06, "90th_percentile": 229.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Electrocardiogram tracing", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 249.25, "discounted_cash": 149.55, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 224.33, "10th_percentile": 109.17, "90th_percentile": 224.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 224.33, "10th_percentile": 109.17, "90th_percentile": 224.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "210", "median_amount": 73.55, "10th_percentile": 58.84, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "175", "median_amount": 196.75, "10th_percentile": 148.54, "90th_percentile": 210.55, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "1 through 10", "median_amount": 169.66, "10th_percentile": 169.66, "90th_percentile": 169.66, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.37, "10th_percentile": 48.95, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "157", "median_amount": 72.08, "10th_percentile": 57.66, "90th_percentile": 75.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.72, "10th_percentile": 21.65, "90th_percentile": 97.05, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "507", "median_amount": 25.58, "10th_percentile": 24.41, "90th_percentile": 26.87, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "152", "median_amount": 72.81, "10th_percentile": 69.25, "90th_percentile": 76.50, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "94", "median_amount": 72.08, "10th_percentile": 27.27, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "423", "median_amount": 72.08, "10th_percentile": 45.44, "90th_percentile": 75.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.55, "10th_percentile": 183.69, "90th_percentile": 229.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 218.55, "10th_percentile": 183.69, "90th_percentile": 229.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 67.80, "10th_percentile": 59.33, "90th_percentile": 84.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "19", "median_amount": 229.61, "10th_percentile": 202.06, "90th_percentile": 229.61, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "19", "median_amount": 229.61, "10th_percentile": 202.06, "90th_percentile": 229.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ekg interp & report", "code_information": [ { "code": "93010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 68.75, "discounted_cash": 41.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 7.38, "10th_percentile": 7.09, "90th_percentile": 7.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrocardiogram report", "code_information": [ { "code": "93010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 68.75, "discounted_cash": 41.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "105", "median_amount": 7.38, "10th_percentile": 7.09, "90th_percentile": 7.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiovascular stress test", "code_information": [ { "code": "93016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.50, "discounted_cash": 39.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 18.29, "10th_percentile": 18.13, "90th_percentile": 18.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Stress test supervision", "code_information": [ { "code": "93016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.50, "discounted_cash": 39.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 18.29, "10th_percentile": 18.13, "90th_percentile": 18.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiovascular stress test", "code_information": [ { "code": "93017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1331.50, "discounted_cash": 798.90, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1169.78, "10th_percentile": 1146.91, "90th_percentile": 1192.63, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1169.78, "10th_percentile": 1146.91, "90th_percentile": 1192.63, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 393.08, "10th_percentile": 330.22, "90th_percentile": 412.77, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "48", "median_amount": 1000.39, "10th_percentile": 777.00, "90th_percentile": 1120.28, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 390.90, "10th_percentile": 298.54, "90th_percentile": 1058.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 130.78, "10th_percentile": 130.49, "90th_percentile": 143.54, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "13", "median_amount": 389.15, "10th_percentile": 389.15, "90th_percentile": 408.64, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 336.22, "10th_percentile": 308.17, "90th_percentile": 396.24, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 269.66, "10th_percentile": 242.71, "90th_percentile": 380.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1091.94, "10th_percentile": 1003.40, "90th_percentile": 1180.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1091.94, "10th_percentile": 1003.40, "90th_percentile": 1180.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 362.17, "10th_percentile": 344.90, "90th_percentile": 362.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Stress testing", "code_information": [ { "code": "93017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1331.50, "discounted_cash": 798.90, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1169.78, "10th_percentile": 1146.91, "90th_percentile": 1192.63, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1169.78, "10th_percentile": 1146.91, "90th_percentile": 1192.63, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 393.08, "10th_percentile": 330.22, "90th_percentile": 412.77, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "48", "median_amount": 1000.39, "10th_percentile": 777.00, "90th_percentile": 1120.28, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 390.90, "10th_percentile": 298.54, "90th_percentile": 1058.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 130.78, "10th_percentile": 130.49, "90th_percentile": 143.54, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "13", "median_amount": 389.15, "10th_percentile": 389.15, "90th_percentile": 408.64, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 336.22, "10th_percentile": 308.17, "90th_percentile": 396.24, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 269.66, "10th_percentile": 242.71, "90th_percentile": 380.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1091.94, "10th_percentile": 1003.40, "90th_percentile": 1180.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1091.94, "10th_percentile": 1003.40, "90th_percentile": 1180.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 362.17, "10th_percentile": 344.90, "90th_percentile": 362.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiovascular stress test", "code_information": [ { "code": "93018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.25, "discounted_cash": 25.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 12.04, "10th_percentile": 12.04, "90th_percentile": 12.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Stress test report", "code_information": [ { "code": "93018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.25, "discounted_cash": 25.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 12.04, "10th_percentile": 12.04, "90th_percentile": 12.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecg monit/reprt up to 48 hrs", "code_information": [ { "code": "93225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 533.50, "discounted_cash": 320.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 156.44, "10th_percentile": 140.48, "90th_percentile": 165.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 370.30, "10th_percentile": 347.08, "90th_percentile": 384.73, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 118.30, "10th_percentile": 56.85, "90th_percentile": 162.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.18, "10th_percentile": 59.18, "90th_percentile": 59.18, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 52.28, "10th_percentile": 52.28, "90th_percentile": 54.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 158.73, "10th_percentile": 154.73, "90th_percentile": 162.73, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.46, "10th_percentile": 123.46, "90th_percentile": 123.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 113.46, "10th_percentile": 97.25, "90th_percentile": 154.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 145.11, "10th_percentile": 132.41, "90th_percentile": 170.51, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 442.31, "10th_percentile": 442.31, "90th_percentile": 442.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 442.31, "10th_percentile": 442.31, "90th_percentile": 442.31, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Holter rec connect disconnect", "code_information": [ { "code": "93225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 533.50, "discounted_cash": 320.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 156.44, "10th_percentile": 140.48, "90th_percentile": 165.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 370.30, "10th_percentile": 347.08, "90th_percentile": 384.73, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 118.30, "10th_percentile": 56.85, "90th_percentile": 162.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 59.18, "10th_percentile": 59.18, "90th_percentile": 59.18, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 52.28, "10th_percentile": 52.28, "90th_percentile": 54.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 158.73, "10th_percentile": 154.73, "90th_percentile": 162.73, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 123.46, "10th_percentile": 123.46, "90th_percentile": 123.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 113.46, "10th_percentile": 97.25, "90th_percentile": 154.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 145.11, "10th_percentile": 132.41, "90th_percentile": 170.51, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 442.31, "10th_percentile": 442.31, "90th_percentile": 442.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 442.31, "10th_percentile": 442.31, "90th_percentile": 442.31, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ecg monit/reprt up to 48 hrs", "code_information": [ { "code": "93226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 533.50, "discounted_cash": 320.10, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Holter monitor scanning", "code_information": [ { "code": "93226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 533.50, "discounted_cash": 320.10, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecg monit/reprt up to 48 hrs", "code_information": [ { "code": "93227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.53, "10th_percentile": 15.53, "90th_percentile": 15.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Holter monitor interp & report", "code_information": [ { "code": "93227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 207.50, "discounted_cash": 124.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.53, "10th_percentile": 15.53, "90th_percentile": 15.63, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ecg remote 30 day w/ i& report", "code_information": [ { "code": "93228", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.75, "discounted_cash": 58.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remote 30 day ecg rev/report", "code_information": [ { "code": "93228", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.75, "discounted_cash": 58.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ecg>48hr<7d recording", "code_information": [ { "code": "93242", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 263.75, "discounted_cash": 158.25, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.08, "10th_percentile": 48.08, "90th_percentile": 48.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ekg hook rec >48h to 7days", "code_information": [ { "code": "93242", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 263.75, "discounted_cash": 158.25, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.08, "10th_percentile": 48.08, "90th_percentile": 48.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ecg>48hr<7d rev&interpj", "code_information": [ { "code": "93244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.75, "discounted_cash": 49.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ekg interp >48h to 7days", "code_information": [ { "code": "93244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.75, "discounted_cash": 49.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ecg>7d<15d recording", "code_information": [ { "code": "93246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 263.75, "discounted_cash": 158.25, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ekg hook rec >7d to 15d", "code_information": [ { "code": "93246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 263.75, "discounted_cash": 158.25, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ecg>7d<15d rev&interpj", "code_information": [ { "code": "93248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.75, "discounted_cash": 49.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ext ekg interp >7d to 15 days", "code_information": [ { "code": "93248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.75, "discounted_cash": 49.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Event rec connect disconnect", "code_information": [ { "code": "93270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 176.25, "discounted_cash": 105.75, "minimum": 33.17, "maximum": 97.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.64, "10th_percentile": 44.21, "90th_percentile": 54.64, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 97.25, "count": "1 through 10", "median_amount": 136.30, "10th_percentile": 104.72, "90th_percentile": 148.97, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.08, "10th_percentile": 17.28, "90th_percentile": 18.08, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.17, "count": "1 through 10", "median_amount": 52.79, "10th_percentile": 51.75, "90th_percentile": 53.83, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.68, "10th_percentile": 9.39, "90th_percentile": 37.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.94, "10th_percentile": 41.53, "90th_percentile": 47.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Remote 30 day ecg rev/report", "code_information": [ { "code": "93270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 176.25, "discounted_cash": 105.75, "minimum": 33.17, "maximum": 97.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.64, "10th_percentile": 44.21, "90th_percentile": 54.64, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 97.25, "count": "1 through 10", "median_amount": 136.30, "10th_percentile": 104.72, "90th_percentile": 148.97, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.08, "10th_percentile": 17.28, "90th_percentile": 18.08, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.17, "count": "1 through 10", "median_amount": 52.79, "10th_percentile": 51.75, "90th_percentile": 53.83, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.68, "10th_percentile": 9.39, "90th_percentile": 37.72, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.94, "10th_percentile": 41.53, "90th_percentile": 47.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ecg/review interpret only", "code_information": [ { "code": "93272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 199.00, "discounted_cash": 119.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Event record review & interp", "code_information": [ { "code": "93272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 199.00, "discounted_cash": 119.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Interrog evl pm/ldls pm ip", "code_information": [ { "code": "93288", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 387.36, "discounted_cash": 232.42, "minimum": 33.17, "maximum": 97.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Interrog device eval heart", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.25, "discounted_cash": 52.95, "minimum": 33.17, "maximum": 97.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Interrogation eval defib", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.25, "discounted_cash": 52.95, "minimum": 33.17, "maximum": 97.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tte w/doppler complete", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2662.75, "discounted_cash": 1597.65, "minimum": 487.72, "maximum": 1429.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "124", "median_amount": 260.95, "10th_percentile": 59.30, "90th_percentile": 273.35, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 487.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tte f-up or lmtd", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1904.50, "discounted_cash": 1142.70, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 195.52, "10th_percentile": 195.52, "90th_percentile": 195.52, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echo limited interpretation", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.50, "discounted_cash": 34.50, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echo limited", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1904.50, "discounted_cash": 1142.70, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 449.81, "10th_percentile": 449.81, "90th_percentile": 449.81, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "1 through 10", "median_amount": 1526.04, "10th_percentile": 1526.04, "90th_percentile": 1526.04, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 451.19, "10th_percentile": 353.19, "90th_percentile": 638.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "1 through 10", "median_amount": 572.00, "10th_percentile": 561.99, "90th_percentile": 582.00, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 578.59, "10th_percentile": 556.53, "90th_percentile": 578.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 478.02, "10th_percentile": 419.62, "90th_percentile": 536.42, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 592.17, "10th_percentile": 472.47, "90th_percentile": 638.27, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echo stress test", "code_information": [ { "code": "93350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 617.50, "discounted_cash": 370.50, "minimum": 487.72, "maximum": 1429.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 487.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Stress tte only", "code_information": [ { "code": "93350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 617.50, "discounted_cash": 370.50, "minimum": 487.72, "maximum": 1429.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 487.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echocardiography stress", "code_information": [ { "code": "93350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1968.00, "discounted_cash": 1180.80, "minimum": 487.72, "maximum": 1429.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1429.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 487.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiac rehab", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 343.50, "discounted_cash": 206.10, "minimum": 112.00, "maximum": 328.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 328.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 328.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 112.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiac rehab wo monitoring", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 343.50, "discounted_cash": 206.10, "minimum": 112.00, "maximum": 328.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 328.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 328.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 112.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiac rehab w cont monitor", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 343.50, "discounted_cash": 206.10, "minimum": 112.00, "maximum": 328.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 101.37, "10th_percentile": 81.10, "90th_percentile": 106.49, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 328.37, "count": "1 through 10", "median_amount": 275.12, "10th_percentile": 275.12, "90th_percentile": 275.12, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 328.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 104.36, "10th_percentile": 84.64, "90th_percentile": 104.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.66, "10th_percentile": 33.66, "90th_percentile": 33.66, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 112.00, "count": "12", "median_amount": 105.42, "10th_percentile": 100.36, "90th_percentile": 105.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.99, "10th_percentile": 85.79, "90th_percentile": 104.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.49, "10th_percentile": 78.27, "90th_percentile": 99.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.31, "10th_percentile": 77.83, "90th_percentile": 116.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiac rehab/monitor", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 343.50, "discounted_cash": 206.10, "minimum": 112.00, "maximum": 328.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 101.37, "10th_percentile": 81.10, "90th_percentile": 106.49, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 328.37, "count": "1 through 10", "median_amount": 275.12, "10th_percentile": 275.12, "90th_percentile": 275.12, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 328.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 104.36, "10th_percentile": 84.64, "90th_percentile": 104.36, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.66, "10th_percentile": 33.66, "90th_percentile": 33.66, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 112.00, "count": "12", "median_amount": 105.42, "10th_percentile": 100.36, "90th_percentile": 105.42, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.99, "10th_percentile": 85.79, "90th_percentile": 104.19, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.49, "10th_percentile": 78.27, "90th_percentile": 99.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.31, "10th_percentile": 77.83, "90th_percentile": 116.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiovascular procedure", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thrombolysis cornary iv inf", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extracranial bilat study", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1273.50, "discounted_cash": 764.10, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arterial duplex carotid bil", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1273.50, "discounted_cash": 764.10, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 873.18, "10th_percentile": 873.18, "90th_percentile": 873.18, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 873.18, "10th_percentile": 873.18, "90th_percentile": 873.18, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 375.95, "10th_percentile": 282.76, "90th_percentile": 394.79, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "1 through 10", "median_amount": 948.66, "10th_percentile": 571.74, "90th_percentile": 1025.48, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 377.66, "10th_percentile": 313.22, "90th_percentile": 386.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 348.83, "10th_percentile": 348.83, "90th_percentile": 348.83, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 130.73, "10th_percentile": 124.55, "90th_percentile": 131.39, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "1 through 10", "median_amount": 375.84, "10th_percentile": 364.65, "90th_percentile": 384.84, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 331.59, "10th_percentile": 302.11, "90th_percentile": 361.06, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 257.90, "10th_percentile": 232.14, "90th_percentile": 375.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 329.87, "10th_percentile": 283.45, "90th_percentile": 341.43, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extracranial uni/ltd study", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arterial duplex carotid uni", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 306.43, "10th_percentile": 306.43, "90th_percentile": 306.43, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abi upper lower extremity", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 933.50, "discounted_cash": 560.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 272.49, "10th_percentile": 238.73, "90th_percentile": 289.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 594.64, "10th_percentile": 567.71, "90th_percentile": 621.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 283.60, "10th_percentile": 250.48, "90th_percentile": 849.81, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 862.19, "10th_percentile": 862.19, "90th_percentile": 862.19, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.12, "10th_percentile": 74.00, "90th_percentile": 93.22, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 286.50, "10th_percentile": 274.49, "90th_percentile": 286.50, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 170.16, "10th_percentile": 165.29, "90th_percentile": 198.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 232.75, "10th_percentile": 211.58, "90th_percentile": 253.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Upr/l xtremity art 2 levels", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 933.50, "discounted_cash": 560.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 272.49, "10th_percentile": 238.73, "90th_percentile": 289.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 594.64, "10th_percentile": 567.71, "90th_percentile": 621.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 283.60, "10th_percentile": 250.48, "90th_percentile": 849.81, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 862.19, "10th_percentile": 862.19, "90th_percentile": 862.19, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.12, "10th_percentile": 74.00, "90th_percentile": 93.22, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 286.50, "10th_percentile": 274.49, "90th_percentile": 286.50, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 170.16, "10th_percentile": 165.29, "90th_percentile": 198.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 232.75, "10th_percentile": 211.58, "90th_percentile": 253.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abi upper lower ext w sp", "code_information": [ { "code": "93923", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1156.00, "discounted_cash": 693.60, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Upr/lxtr art stdy 3+ lvls", "code_information": [ { "code": "93923", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1156.00, "discounted_cash": 693.60, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lower extremity study", "code_information": [ { "code": "93925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1904.50, "discounted_cash": 1142.70, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arterial duplex low ext bil", "code_information": [ { "code": "93925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1904.50, "discounted_cash": 1142.70, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 590.40, "10th_percentile": 590.40, "90th_percentile": 590.40, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "1 through 10", "median_amount": 1144.53, "10th_percentile": 457.64, "90th_percentile": 1403.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 551.01, "10th_percentile": 309.53, "90th_percentile": 562.91, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 462.87, "10th_percentile": 462.87, "90th_percentile": 462.87, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 186.64, "10th_percentile": 181.31, "90th_percentile": 201.39, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "1 through 10", "median_amount": 584.50, "10th_percentile": 584.50, "90th_percentile": 584.50, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 506.36, "10th_percentile": 450.26, "90th_percentile": 540.40, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 347.16, "10th_percentile": 347.16, "90th_percentile": 526.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 647.53, "10th_percentile": 543.92, "90th_percentile": 647.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lower extremity study", "code_information": [ { "code": "93926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arterial duplex lower ext lt", "code_information": [ { "code": "93926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 711.42, "10th_percentile": 711.42, "90th_percentile": 711.42, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 521.48, "10th_percentile": 521.48, "90th_percentile": 521.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.75, "10th_percentile": 89.21, "90th_percentile": 96.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arterial duplex lower ext rt", "code_information": [ { "code": "93926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 758.28, "10th_percentile": 758.28, "90th_percentile": 758.28, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 370.26, "10th_percentile": 249.28, "90th_percentile": 491.24, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 173.40, "10th_percentile": 85.00, "90th_percentile": 239.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 204.27, "10th_percentile": 204.27, "90th_percentile": 204.27, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arterial duplex lower ext rt", "code_information": [ { "code": "93926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Upper extremity study", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1904.50, "discounted_cash": 1142.70, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duplex ue art/bpg uni limit rt", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1904.50, "discounted_cash": 1142.70, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duplex ue art/bpg uni limit rt", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1904.50, "discounted_cash": 1142.70, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Upper extremity study", "code_information": [ { "code": "93931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duplex ue art/bpg uni limit lt", "code_information": [ { "code": "93931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duplex ue art/bpg uni limit lt", "code_information": [ { "code": "93931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extremity study", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1273.50, "discounted_cash": 764.10, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venous duplex extremity bil", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1273.50, "discounted_cash": 764.10, "minimum": 215.01, "maximum": 630.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1066.48, "10th_percentile": 1066.48, "90th_percentile": 1066.48, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1066.48, "10th_percentile": 1066.48, "90th_percentile": 1066.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 394.79, "10th_percentile": 394.79, "90th_percentile": 394.79, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 630.40, "count": "1 through 10", "median_amount": 862.85, "10th_percentile": 862.85, "90th_percentile": 862.85, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 630.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 367.29, "10th_percentile": 321.07, "90th_percentile": 367.29, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 367.29, "10th_percentile": 367.29, "90th_percentile": 367.29, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 130.73, "10th_percentile": 126.58, "90th_percentile": 135.32, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 215.01, "count": "1 through 10", "median_amount": 365.84, "10th_percentile": 365.84, "90th_percentile": 365.84, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 386.89, "10th_percentile": 386.89, "90th_percentile": 386.89, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 232.14, "10th_percentile": 221.06, "90th_percentile": 325.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 346.39, "10th_percentile": 316.08, "90th_percentile": 346.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extremity study", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venous dopplr up/low ext left", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 251.45, "10th_percentile": 216.05, "90th_percentile": 279.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 734.85, "10th_percentile": 716.11, "90th_percentile": 753.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 241.14, "10th_percentile": 127.25, "90th_percentile": 273.80, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 88.33, "10th_percentile": 84.11, "90th_percentile": 92.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 270.00, "10th_percentile": 252.90, "90th_percentile": 276.60, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 254.39, "10th_percentile": 214.83, "90th_percentile": 279.39, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 219.04, "10th_percentile": 162.71, "90th_percentile": 273.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 245.14, "10th_percentile": 153.12, "90th_percentile": 297.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 790.62, "10th_percentile": 790.62, "90th_percentile": 790.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 790.62, "10th_percentile": 790.62, "90th_percentile": 790.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Venous doppler lower ext rt", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 266.06, "10th_percentile": 266.06, "90th_percentile": 266.06, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 737.36, "10th_percentile": 412.03, "90th_percentile": 777.96, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 241.14, "10th_percentile": 104.40, "90th_percentile": 342.22, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 92.52, "10th_percentile": 63.22, "90th_percentile": 92.52, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 248.40, "10th_percentile": 248.40, "90th_percentile": 248.40, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 215.97, "10th_percentile": 215.97, "90th_percentile": 215.97, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.28, "10th_percentile": 164.28, "90th_percentile": 268.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 245.14, "10th_percentile": 245.14, "90th_percentile": 245.14, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 245.14, "10th_percentile": 245.14, "90th_percentile": 245.14, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 291.81, "10th_percentile": 123.72, "90th_percentile": 303.51, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 830.23, "10th_percentile": 830.23, "90th_percentile": 830.23, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 830.23, "10th_percentile": 830.23, "90th_percentile": 830.23, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Venous doppler lower ext rt", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vascular study", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duplex arterial flow limited", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.25, "discounted_cash": 540.75, "minimum": 94.59, "maximum": 277.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 266.06, "10th_percentile": 223.49, "90th_percentile": 276.72, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 277.33, "count": "1 through 10", "median_amount": 676.42, "10th_percentile": 444.24, "90th_percentile": 741.91, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 277.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 241.14, "10th_percentile": 218.36, "90th_percentile": 250.28, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 254.20, "10th_percentile": 254.20, "90th_percentile": 254.20, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.10, "10th_percentile": 30.86, "90th_percentile": 92.52, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 94.59, "count": "1 through 10", "median_amount": 270.00, "10th_percentile": 264.72, "90th_percentile": 275.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 173.40, "10th_percentile": 166.10, "90th_percentile": 180.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vent assist & manage day 1", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1152.25, "discounted_cash": 691.35, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vent mgmt inpat init day", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1152.25, "discounted_cash": 691.35, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vent assist & manage sub day", "code_information": [ { "code": "94003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1152.25, "discounted_cash": 691.35, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vent mgmt inpat subq day", "code_information": [ { "code": "94003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1152.25, "discounted_cash": 691.35, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breathing capacity test", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spirometry interpretation", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.75, "discounted_cash": 47.85, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 7.30, "10th_percentile": 6.85, "90th_percentile": 7.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spirometry (pft)", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 252.65, "10th_percentile": 252.65, "90th_percentile": 252.65, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 252.65, "10th_percentile": 252.65, "90th_percentile": 252.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.37, "10th_percentile": 32.37, "90th_percentile": 32.37, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluation of wheezing", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 626.25, "discounted_cash": 375.75, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "1 through 10", "median_amount": 530.38, "10th_percentile": 530.38, "90th_percentile": 530.38, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 794.20, "10th_percentile": 626.30, "90th_percentile": 962.10, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 114.16, "10th_percentile": 114.16, "90th_percentile": 114.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bronchospasm pre & post interp", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 28.20, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bronchpspasm evaluaton", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 626.25, "discounted_cash": 375.75, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 184.84, "10th_percentile": 147.87, "90th_percentile": 194.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "41", "median_amount": 447.88, "10th_percentile": 352.98, "90th_percentile": 526.92, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "61", "median_amount": 368.51, "10th_percentile": 309.64, "90th_percentile": 426.15, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 265.10, "10th_percentile": 123.24, "90th_percentile": 346.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 64.28, "10th_percentile": 58.44, "90th_percentile": 67.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "21", "median_amount": 182.99, "10th_percentile": 162.99, "90th_percentile": 192.20, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 152.20, "10th_percentile": 137.25, "90th_percentile": 194.14, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "63", "median_amount": 114.16, "10th_percentile": 108.69, "90th_percentile": 149.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 555.99, "10th_percentile": 555.99, "90th_percentile": 555.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 555.99, "10th_percentile": 555.99, "90th_percentile": 555.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 162.18, "10th_percentile": 125.73, "90th_percentile": 189.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vital capacity test", "code_information": [ { "code": "94150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vital capacity total", "code_information": [ { "code": "94150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung function test (mbc/mvv)", "code_information": [ { "code": "94200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.75, "discounted_cash": 118.65, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Maximum breathing capacity", "code_information": [ { "code": "94200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.75, "discounted_cash": 118.65, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulmonary stress testing", "code_information": [ { "code": "94618", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 26.17, "10th_percentile": 19.99, "90th_percentile": 27.41, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulmonary stress test interp", "code_information": [ { "code": "94618", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23.75, "discounted_cash": 14.25, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulmonary stress test", "code_information": [ { "code": "94618", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.82, "10th_percentile": 73.78, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "1 through 10", "median_amount": 198.63, "10th_percentile": 176.63, "90th_percentile": 220.63, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 81.11, "10th_percentile": 66.13, "90th_percentile": 81.11, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 73.84, "10th_percentile": 66.69, "90th_percentile": 80.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.41, "10th_percentile": 26.42, "90th_percentile": 28.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 78.03, "10th_percentile": 78.03, "90th_percentile": 79.99, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 54.07, "10th_percentile": 47.74, "90th_percentile": 78.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.62, "10th_percentile": 72.62, "90th_percentile": 72.62, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phy/qhp op pulm rhb w/o mntr", "code_information": [ { "code": "94625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulmonary rehab wo cont ox mnt", "code_information": [ { "code": "94625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phy/qhp op pulm rhb w/mntr", "code_information": [ { "code": "94626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.07, "10th_percentile": 51.07, "90th_percentile": 51.07, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.12, "10th_percentile": 120.12, "90th_percentile": 120.12, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.82, "10th_percentile": 37.82, "90th_percentile": 37.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.90, "10th_percentile": 16.15, "90th_percentile": 16.90, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "1 through 10", "median_amount": 50.56, "10th_percentile": 49.09, "90th_percentile": 50.56, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.10, "10th_percentile": 38.10, "90th_percentile": 38.10, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.82, "10th_percentile": 44.82, "90th_percentile": 44.82, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulmonary rehab w cont ox mntr", "code_information": [ { "code": "94626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.07, "10th_percentile": 51.07, "90th_percentile": 51.07, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.12, "10th_percentile": 120.12, "90th_percentile": 120.12, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 37.82, "10th_percentile": 37.82, "90th_percentile": 37.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.90, "10th_percentile": 16.15, "90th_percentile": 16.90, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "1 through 10", "median_amount": 50.56, "10th_percentile": 49.09, "90th_percentile": 50.56, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.10, "10th_percentile": 38.10, "90th_percentile": 38.10, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.82, "10th_percentile": 44.82, "90th_percentile": 44.82, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Airway inhalation treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "minimum": 180.92, "maximum": 530.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 129.21, "10th_percentile": 129.21, "90th_percentile": 129.21, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 129.21, "10th_percentile": 129.21, "90th_percentile": 129.21, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 103.46, "10th_percentile": 98.50, "90th_percentile": 283.69, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 530.43, "count": "13", "median_amount": 280.82, "10th_percentile": 197.50, "90th_percentile": 398.36, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 279.70, "10th_percentile": 66.66, "90th_percentile": 289.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "85", "median_amount": 34.25, "10th_percentile": 32.71, "90th_percentile": 121.67, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 180.92, "count": "13", "median_amount": 195.03, "10th_percentile": 102.43, "90th_percentile": 565.60, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.96, "10th_percentile": 82.77, "90th_percentile": 267.00, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 101.40, "10th_percentile": 96.53, "90th_percentile": 202.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.04, "10th_percentile": 86.43, "90th_percentile": 290.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inhalation tx sputum induction", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "minimum": 180.92, "maximum": 530.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 129.21, "10th_percentile": 129.21, "90th_percentile": 129.21, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 129.21, "10th_percentile": 129.21, "90th_percentile": 129.21, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 103.46, "10th_percentile": 98.50, "90th_percentile": 283.69, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 530.43, "count": "13", "median_amount": 280.82, "10th_percentile": 197.50, "90th_percentile": 398.36, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 279.70, "10th_percentile": 66.66, "90th_percentile": 289.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "85", "median_amount": 34.25, "10th_percentile": 32.71, "90th_percentile": 121.67, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 180.92, "count": "13", "median_amount": 195.03, "10th_percentile": 102.43, "90th_percentile": 565.60, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.96, "10th_percentile": 82.77, "90th_percentile": 267.00, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 101.40, "10th_percentile": 96.53, "90th_percentile": 202.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 108.04, "10th_percentile": 86.43, "90th_percentile": 290.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cbt 1st hour", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.17, "10th_percentile": 26.17, "90th_percentile": 26.17, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 78.03, "10th_percentile": 78.03, "90th_percentile": 78.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.81, "10th_percentile": 88.46, "90th_percentile": 147.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Continuous inhal tx 1st hr", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.17, "10th_percentile": 26.17, "90th_percentile": 26.17, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 78.03, "10th_percentile": 78.03, "90th_percentile": 78.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.81, "10th_percentile": 88.46, "90th_percentile": 147.15, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cbt each addl hour", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Continuous inhal tx ea add hr", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pos airway pressure cpap", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 444.75, "discounted_cash": 266.85, "minimum": 180.92, "maximum": 530.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.59, "10th_percentile": 41.92, "90th_percentile": 43.59, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 180.92, "count": "1 through 10", "median_amount": 129.97, "10th_percentile": 129.97, "90th_percentile": 129.97, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 128.67, "10th_percentile": 128.67, "90th_percentile": 133.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.98, "10th_percentile": 120.98, "90th_percentile": 120.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pos airway pressure cpap bipap", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 444.75, "discounted_cash": 266.85, "minimum": 180.92, "maximum": 530.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.59, "10th_percentile": 41.92, "90th_percentile": 43.59, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 180.92, "count": "1 through 10", "median_amount": 129.97, "10th_percentile": 129.97, "90th_percentile": 129.97, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 128.67, "10th_percentile": 128.67, "90th_percentile": 133.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 120.98, "10th_percentile": 120.98, "90th_percentile": 120.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluate pt use of inhaler", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "minimum": 180.92, "maximum": 530.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 285.98, "10th_percentile": 261.45, "90th_percentile": 297.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 285.98, "10th_percentile": 261.45, "90th_percentile": 297.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.13, "10th_percentile": 53.46, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 530.43, "count": "13", "median_amount": 238.70, "10th_percentile": 199.66, "90th_percentile": 280.82, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.66, "10th_percentile": 116.44, "90th_percentile": 236.88, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 32.71, "10th_percentile": 32.59, "90th_percentile": 32.71, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 180.92, "count": "1 through 10", "median_amount": 102.43, "10th_percentile": 98.99, "90th_percentile": 102.43, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 101.40, "10th_percentile": 77.23, "90th_percentile": 101.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 166.20, "10th_percentile": 102.38, "90th_percentile": 230.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 166.20, "10th_percentile": 102.38, "90th_percentile": 230.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.78, "10th_percentile": 73.16, "90th_percentile": 95.32, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mdi evaluation demonstration", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.75, "discounted_cash": 200.25, "minimum": 180.92, "maximum": 530.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 285.98, "10th_percentile": 261.45, "90th_percentile": 297.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 285.98, "10th_percentile": 261.45, "90th_percentile": 297.50, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.13, "10th_percentile": 53.46, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 530.43, "count": "13", "median_amount": 238.70, "10th_percentile": 199.66, "90th_percentile": 280.82, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 530.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 176.66, "10th_percentile": 116.44, "90th_percentile": 236.88, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 32.71, "10th_percentile": 32.59, "90th_percentile": 32.71, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 180.92, "count": "1 through 10", "median_amount": 102.43, "10th_percentile": 98.99, "90th_percentile": 102.43, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 103.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 101.40, "10th_percentile": 77.23, "90th_percentile": 101.40, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 166.20, "10th_percentile": 102.38, "90th_percentile": 230.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 166.20, "10th_percentile": 102.38, "90th_percentile": 230.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.78, "10th_percentile": 73.16, "90th_percentile": 95.32, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chest wall manipulation", "code_information": [ { "code": "94667", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.92, "10th_percentile": 24.92, "90th_percentile": 26.17, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 78.03, "10th_percentile": 78.03, "90th_percentile": 78.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.25, "10th_percentile": 77.25, "90th_percentile": 139.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Percussion initial evaluation", "code_information": [ { "code": "94667", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.77, "10th_percentile": 82.77, "90th_percentile": 82.77, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.92, "10th_percentile": 24.92, "90th_percentile": 26.17, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 78.03, "10th_percentile": 78.03, "90th_percentile": 78.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.25, "10th_percentile": 77.25, "90th_percentile": 139.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chest wall manipulation", "code_information": [ { "code": "94668", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 26.17, "10th_percentile": 26.17, "90th_percentile": 157.00, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 156.06, "10th_percentile": 156.06, "90th_percentile": 156.06, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Percussion subsequent", "code_information": [ { "code": "94668", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 26.17, "10th_percentile": 26.17, "90th_percentile": 157.00, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "1 through 10", "median_amount": 156.06, "10th_percentile": 156.06, "90th_percentile": 156.06, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulm funct tst plethysmograp", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 939.00, "discounted_cash": 563.40, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulm funct tst plethysmography", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 939.00, "discounted_cash": 563.40, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulm function test by gas", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "1 through 10", "median_amount": 419.65, "10th_percentile": 419.65, "90th_percentile": 419.65, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 442.71, "10th_percentile": 442.71, "90th_percentile": 442.71, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.33, "10th_percentile": 90.33, "90th_percentile": 90.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulm function test by gas", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 226.76, "10th_percentile": 226.76, "90th_percentile": 226.76, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 226.76, "10th_percentile": 226.76, "90th_percentile": 226.76, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 133.61, "10th_percentile": 116.99, "90th_percentile": 153.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "40", "median_amount": 356.70, "10th_percentile": 311.19, "90th_percentile": 398.90, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 160.22, "10th_percentile": 160.22, "90th_percentile": 160.22, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 50.85, "10th_percentile": 46.24, "90th_percentile": 53.42, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "20", "median_amount": 144.78, "10th_percentile": 144.78, "90th_percentile": 152.07, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 148.47, "10th_percentile": 114.65, "90th_percentile": 153.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "58", "median_amount": 95.33, "10th_percentile": 85.99, "90th_percentile": 120.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 456.45, "10th_percentile": 456.45, "90th_percentile": 456.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 456.45, "10th_percentile": 456.45, "90th_percentile": 456.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 131.55, "10th_percentile": 123.13, "90th_percentile": 147.59, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 347.66, "10th_percentile": 347.66, "90th_percentile": 347.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 347.66, "10th_percentile": 347.66, "90th_percentile": 347.66, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Co/membane diffuse capacity", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.25, "discounted_cash": 91.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.23, "10th_percentile": 92.23, "90th_percentile": 92.23, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Co membrane diffuse capacity", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.25, "discounted_cash": 91.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 109.62, "10th_percentile": 109.62, "90th_percentile": 109.62, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 109.62, "10th_percentile": 109.62, "90th_percentile": 109.62, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 44.95, "10th_percentile": 35.96, "90th_percentile": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.50, "10th_percentile": 15.50, "90th_percentile": 15.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 15.63, "10th_percentile": 14.21, "90th_percentile": 16.41, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 45.63, "10th_percentile": 35.24, "90th_percentile": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "59", "median_amount": 27.76, "10th_percentile": 26.44, "90th_percentile": 37.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 140.25, "10th_percentile": 140.25, "90th_percentile": 140.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 140.25, "10th_percentile": 140.25, "90th_percentile": 140.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 41.42, "10th_percentile": 38.16, "90th_percentile": 44.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Continuous pulse oximetry", "code_information": [ { "code": "94762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Measure blood oxygen level", "code_information": [ { "code": "94762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunotherapy one injection", "code_information": [ { "code": "95115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injection allergy one", "code_information": [ { "code": "95115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunotherapy injections", "code_information": [ { "code": "95117", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "1 through 10", "median_amount": 129.57, "10th_percentile": 129.57, "90th_percentile": 129.57, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.51, "10th_percentile": 44.51, "90th_percentile": 44.51, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.80, "10th_percentile": 15.80, "90th_percentile": 16.60, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.66, "10th_percentile": 44.52, "90th_percentile": 46.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injection allergy 2 or more", "code_information": [ { "code": "95117", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "1 through 10", "median_amount": 129.57, "10th_percentile": 129.57, "90th_percentile": 129.57, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.51, "10th_percentile": 44.51, "90th_percentile": 44.51, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.80, "10th_percentile": 15.80, "90th_percentile": 16.60, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.66, "10th_percentile": 44.52, "90th_percentile": 46.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Multiple sleep latency test", "code_information": [ { "code": "95805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1731.75, "discounted_cash": 1039.05, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sleep latency test mult interp", "code_information": [ { "code": "95805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 203.00, "discounted_cash": 121.80, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sleep latency mult recording", "code_information": [ { "code": "95805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1731.75, "discounted_cash": 1039.05, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sleep study unatt&resp efft", "code_information": [ { "code": "95806", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.70, "10th_percentile": 43.95, "90th_percentile": 53.42, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sleep study unattended interp", "code_information": [ { "code": "95806", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.50, "discounted_cash": 92.70, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sleep study unattended", "code_information": [ { "code": "95806", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 445.95, "10th_percentile": 445.95, "90th_percentile": 445.95, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 445.95, "10th_percentile": 445.95, "90th_percentile": 445.95, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 138.61, "10th_percentile": 122.06, "90th_percentile": 149.93, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "33", "median_amount": 356.13, "10th_percentile": 317.52, "90th_percentile": 415.43, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 143.32, "10th_percentile": 143.32, "90th_percentile": 150.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 150.54, "10th_percentile": 150.54, "90th_percentile": 150.54, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.56, "10th_percentile": 48.56, "90th_percentile": 52.14, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "1 through 10", "median_amount": 134.78, "10th_percentile": 68.61, "90th_percentile": 148.61, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.32, "10th_percentile": 94.32, "90th_percentile": 112.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 100.33, "10th_percentile": 89.51, "90th_percentile": 105.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.78, "10th_percentile": 134.78, "90th_percentile": 134.78, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.78, "10th_percentile": 134.78, "90th_percentile": 134.78, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 134.78, "10th_percentile": 128.32, "90th_percentile": 168.47, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 105.38, "10th_percentile": 93.34, "90th_percentile": 386.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 105.38, "10th_percentile": 93.34, "90th_percentile": 386.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sleep study attended", "code_information": [ { "code": "95807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1731.75, "discounted_cash": 1039.05, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sleep study attended", "code_information": [ { "code": "95807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 205.75, "discounted_cash": 123.45, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sleep study attended", "code_information": [ { "code": "95807", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1731.75, "discounted_cash": 1039.05, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysom 6/> yrs 4/> param", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5384.75, "discounted_cash": 3230.85, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 316.44, "10th_percentile": 147.42, "90th_percentile": 485.46, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysomnography age 6+ att int", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 416.50, "discounted_cash": 249.90, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysomnography age 6+ attend", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5384.75, "discounted_cash": 3230.85, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "1 through 10", "median_amount": 3624.46, "10th_percentile": 1337.80, "90th_percentile": 4176.72, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1246.37, "10th_percentile": 1246.37, "90th_percentile": 1246.37, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 540.53, "10th_percentile": 187.73, "90th_percentile": 893.33, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1569.25, "10th_percentile": 1429.76, "90th_percentile": 1708.74, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1878.85, "10th_percentile": 1577.91, "90th_percentile": 2179.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1878.85, "10th_percentile": 1577.91, "90th_percentile": 2179.79, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Polysom 6/>yrs cpap 4/> parm", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5548.00, "discounted_cash": 3328.80, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 326.34, "10th_percentile": 152.44, "90th_percentile": 500.23, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysom 6/>yrs cpap 4/>inspire", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 432.00, "discounted_cash": 259.20, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysomnography age 6+ w cpap", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5548.00, "discounted_cash": 3328.80, "minimum": 904.98, "maximum": 2653.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1310.37, "10th_percentile": 1310.37, "90th_percentile": 1310.37, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2653.32, "count": "1 through 10", "median_amount": 2989.03, "10th_percentile": 1845.89, "90th_percentile": 4132.18, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2653.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1582.58, "10th_percentile": 1502.30, "90th_percentile": 1637.31, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1587.48, "10th_percentile": 1587.48, "90th_percentile": 1587.48, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 904.98, "count": "1 through 10", "median_amount": 1621.59, "10th_percentile": 1621.58, "90th_percentile": 1621.59, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1556.20, "10th_percentile": 1556.20, "90th_percentile": 1556.20, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1123.64, "10th_percentile": 1011.28, "90th_percentile": 1123.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 335.87, "10th_percentile": 335.87, "90th_percentile": 335.87, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1179.85, "10th_percentile": 1179.85, "90th_percentile": 1179.85, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1179.85, "10th_percentile": 1179.85, "90th_percentile": 1179.85, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Guide nerv destr needle emg", "code_information": [ { "code": "95874", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.75, "discounted_cash": 94.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Guide nerv destr needle emg", "code_information": [ { "code": "95874", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Guide nerv destr needle emg", "code_information": [ { "code": "95874", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.75, "discounted_cash": 94.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w/nerv tst lim", "code_information": [ { "code": "95885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 199.25, "discounted_cash": 119.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w nerve tst limb", "code_information": [ { "code": "95885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 199.25, "discounted_cash": 119.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w nerve tst limb", "code_information": [ { "code": "95885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 71.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc test done w/n test comp", "code_information": [ { "code": "95886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 315.00, "discounted_cash": 189.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.58, "10th_percentile": 14.58, "90th_percentile": 15.34, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc test done w/n test comp", "code_information": [ { "code": "95886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 315.00, "discounted_cash": 189.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc test done w/n test comp", "code_information": [ { "code": "95886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 142.25, "discounted_cash": 85.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.10, "10th_percentile": 24.10, "90th_percentile": 44.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 139.40, "10th_percentile": 83.35, "90th_percentile": 139.40, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.09, "10th_percentile": 32.87, "90th_percentile": 44.10, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.77, "10th_percentile": 25.94, "90th_percentile": 30.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.79, "10th_percentile": 29.21, "90th_percentile": 38.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w/n tst nonext", "code_information": [ { "code": "95887", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.75, "discounted_cash": 76.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w/n tst non ext", "code_information": [ { "code": "95887", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.75, "discounted_cash": 50.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w/n tst nonext", "code_information": [ { "code": "95887", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.75, "discounted_cash": 76.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Motor &/ sens nrve cndj test", "code_information": [ { "code": "95905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 521.25, "discounted_cash": 312.75, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Motor sens nrve conduct test", "code_information": [ { "code": "95905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.75, "discounted_cash": 17.85, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Motor/sens nrve conduct test", "code_information": [ { "code": "95905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 521.25, "discounted_cash": 312.75, "minimum": 354.95, "maximum": 1040.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1040.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 354.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nvr cndj tst 1-2 studies", "code_information": [ { "code": "95907", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 413.00, "discounted_cash": 247.80, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.39, "10th_percentile": 42.39, "90th_percentile": 44.52, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nvr cndj tst 1-2 studies", "code_information": [ { "code": "95907", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.50, "discounted_cash": 70.50, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nvr cndj tst 1-2 studies", "code_information": [ { "code": "95907", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 413.00, "discounted_cash": 247.80, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 128.03, "10th_percentile": 128.03, "90th_percentile": 128.03, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "1 through 10", "median_amount": 291.00, "10th_percentile": 275.33, "90th_percentile": 342.62, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.28, "10th_percentile": 23.42, "90th_percentile": 67.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "1 through 10", "median_amount": 123.72, "10th_percentile": 121.30, "90th_percentile": 126.14, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 95.58, "10th_percentile": 78.03, "90th_percentile": 109.91, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 83.64, "10th_percentile": 75.29, "90th_percentile": 87.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.66, "10th_percentile": 100.28, "90th_percentile": 112.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 3-4 studies", "code_information": [ { "code": "95908", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 782.75, "discounted_cash": 469.65, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 3-4 studies", "code_information": [ { "code": "95908", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.25, "discounted_cash": 87.75, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 3-4 studies", "code_information": [ { "code": "95908", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 782.75, "discounted_cash": 469.65, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "1 through 10", "median_amount": 438.92, "10th_percentile": 438.92, "90th_percentile": 438.92, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 212.91, "10th_percentile": 212.91, "90th_percentile": 212.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 5-6 studies", "code_information": [ { "code": "95909", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 782.75, "discounted_cash": 469.65, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 5-6 studies", "code_information": [ { "code": "95909", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 175.25, "discounted_cash": 105.15, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 5-6 studies", "code_information": [ { "code": "95909", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 782.75, "discounted_cash": 469.65, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 7-8 studies", "code_information": [ { "code": "95910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 782.75, "discounted_cash": 469.65, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 7-8 studies", "code_information": [ { "code": "95910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 234.50, "discounted_cash": 140.70, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 7-8 studies", "code_information": [ { "code": "95910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 782.75, "discounted_cash": 469.65, "minimum": 276.99, "maximum": 812.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 812.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 276.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 9-10 studies", "code_information": [ { "code": "95911", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1443.00, "discounted_cash": 865.80, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 9-10 studies", "code_information": [ { "code": "95911", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 292.25, "discounted_cash": 175.35, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 9-10 studies", "code_information": [ { "code": "95911", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1443.00, "discounted_cash": 865.80, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 11-12 studies", "code_information": [ { "code": "95912", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1443.00, "discounted_cash": 865.80, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 11-12 studies", "code_information": [ { "code": "95912", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 11-12 studies", "code_information": [ { "code": "95912", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1443.00, "discounted_cash": 865.80, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 13/> studies", "code_information": [ { "code": "95913", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1443.00, "discounted_cash": 865.80, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction 13/> study", "code_information": [ { "code": "95913", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 411.50, "discounted_cash": 246.90, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 13/> studies", "code_information": [ { "code": "95913", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1443.00, "discounted_cash": 865.80, "minimum": 471.97, "maximum": 1383.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1383.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 471.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alys smpl sp/pn npgt w/prgrm", "code_information": [ { "code": "95971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.25, "discounted_cash": 72.15, "minimum": 81.65, "maximum": 239.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 81.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Analyze neurostim simple", "code_information": [ { "code": "95971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.25, "discounted_cash": 72.15, "minimum": 81.65, "maximum": 239.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 81.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alys cplx sp/pn npgt w/prgrm", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 97760.29, "discounted_cash": 58656.17, "minimum": 81.65, "maximum": 239.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 81.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alys smpl cn npgt prgrmg", "code_information": [ { "code": "95976", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.75, "discounted_cash": 22.05, "minimum": 33.17, "maximum": 97.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alys smpl cn npgt prgrmg", "code_information": [ { "code": "95976", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.75, "discounted_cash": 22.05, "minimum": 33.17, "maximum": 97.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 97.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alys cplx cn npgt prgrmg", "code_information": [ { "code": "95977", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 50.40, "minimum": 81.65, "maximum": 239.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 81.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alys cplx cn npgt prgrmg", "code_information": [ { "code": "95977", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 50.40, "minimum": 81.65, "maximum": 239.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 239.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 81.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Canalith repositioning proc", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.50, "discounted_cash": 75.90, "minimum": 33.03, "maximum": 96.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 96.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 96.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Canalith repositioning procs", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.50, "discounted_cash": 75.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.44, "10th_percentile": 11.00, "90th_percentile": 38.44, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 60.84, "10th_percentile": 22.54, "90th_percentile": 99.13, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.89, "10th_percentile": 20.89, "90th_percentile": 20.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydration iv infusion init", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 243.74, "10th_percentile": 243.74, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "13", "median_amount": 595.36, "10th_percentile": 293.83, "90th_percentile": 647.73, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 657.82, "10th_percentile": 625.97, "90th_percentile": 714.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 625.97, "10th_percentile": 455.82, "90th_percentile": 657.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 77.06, "10th_percentile": 74.48, "90th_percentile": 83.55, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "1 through 10", "median_amount": 229.80, "10th_percentile": 229.79, "90th_percentile": 237.85, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 227.47, "10th_percentile": 227.47, "90th_percentile": 236.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 126.17, "10th_percentile": 111.47, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 213.86, "10th_percentile": 203.66, "90th_percentile": 213.86, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 618.11, "10th_percentile": 533.16, "90th_percentile": 703.05, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 618.11, "10th_percentile": 533.16, "90th_percentile": 703.05, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iv infusion hydrat 1st31-60min", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 243.74, "10th_percentile": 243.74, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "13", "median_amount": 595.36, "10th_percentile": 293.83, "90th_percentile": 647.73, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 657.82, "10th_percentile": 625.97, "90th_percentile": 714.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 625.97, "10th_percentile": 455.82, "90th_percentile": 657.82, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 77.06, "10th_percentile": 74.48, "90th_percentile": 83.55, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "1 through 10", "median_amount": 229.80, "10th_percentile": 229.79, "90th_percentile": 237.85, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 227.47, "10th_percentile": 227.47, "90th_percentile": 236.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 126.17, "10th_percentile": 111.47, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 213.86, "10th_percentile": 203.66, "90th_percentile": 213.86, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 618.11, "10th_percentile": 533.16, "90th_percentile": 703.05, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 618.11, "10th_percentile": 533.16, "90th_percentile": 703.05, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrate iv infusion add-on", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 110.88, "10th_percentile": 110.88, "90th_percentile": 110.88, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 110.88, "10th_percentile": 110.88, "90th_percentile": 110.88, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 47.74, "10th_percentile": 37.08, "90th_percentile": 390.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "47", "median_amount": 129.57, "10th_percentile": 100.29, "90th_percentile": 378.39, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "1 through 10", "median_amount": 181.40, "10th_percentile": 181.40, "90th_percentile": 181.40, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "86", "median_amount": 101.92, "10th_percentile": 35.77, "90th_percentile": 406.21, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.22, "10th_percentile": 35.77, "90th_percentile": 147.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "83", "median_amount": 15.80, "10th_percentile": 15.09, "90th_percentile": 49.80, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 47.26, "10th_percentile": 44.96, "90th_percentile": 89.92, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.79, "10th_percentile": 43.28, "90th_percentile": 68.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "50", "median_amount": 93.58, "10th_percentile": 44.52, "90th_percentile": 488.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 140.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 140.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 41.89, "10th_percentile": 36.65, "90th_percentile": 251.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 141.86, "10th_percentile": 118.48, "90th_percentile": 429.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 141.86, "10th_percentile": 118.48, "90th_percentile": 429.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iv infusion hydration addl hr", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 110.88, "10th_percentile": 110.88, "90th_percentile": 110.88, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 110.88, "10th_percentile": 110.88, "90th_percentile": 110.88, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 47.74, "10th_percentile": 37.08, "90th_percentile": 390.57, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "47", "median_amount": 129.57, "10th_percentile": 100.29, "90th_percentile": 378.39, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "1 through 10", "median_amount": 181.40, "10th_percentile": 181.40, "90th_percentile": 181.40, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "86", "median_amount": 101.92, "10th_percentile": 35.77, "90th_percentile": 406.21, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.22, "10th_percentile": 35.77, "90th_percentile": 147.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "83", "median_amount": 15.80, "10th_percentile": 15.09, "90th_percentile": 49.80, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 47.26, "10th_percentile": 44.96, "90th_percentile": 89.92, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.79, "10th_percentile": 43.28, "90th_percentile": 68.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "50", "median_amount": 93.58, "10th_percentile": 44.52, "90th_percentile": 488.60, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 140.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 140.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 41.89, "10th_percentile": 36.65, "90th_percentile": 251.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 141.86, "10th_percentile": 118.48, "90th_percentile": 429.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 141.86, "10th_percentile": 118.48, "90th_percentile": 429.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iv infusion dx initial 1 hr", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 232.11, "10th_percentile": 185.69, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "36", "median_amount": 629.96, "10th_percentile": 511.08, "90th_percentile": 663.71, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "102", "median_amount": 711.37, "10th_percentile": 328.17, "90th_percentile": 770.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 644.35, "10th_percentile": 556.23, "90th_percentile": 733.77, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "115", "median_amount": 77.06, "10th_percentile": 74.24, "90th_percentile": 84.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "19", "median_amount": 229.79, "10th_percentile": 206.09, "90th_percentile": 241.30, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 227.47, "10th_percentile": 181.98, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "75", "median_amount": 227.47, "10th_percentile": 122.27, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 309.04, "90th_percentile": 717.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 309.04, "90th_percentile": 717.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 213.86, "10th_percentile": 187.13, "90th_percentile": 267.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 724.29, "10th_percentile": 608.40, "90th_percentile": 732.58, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 724.29, "10th_percentile": 608.40, "90th_percentile": 732.58, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ther/proph/diag iv inf init", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 232.11, "10th_percentile": 185.69, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "36", "median_amount": 629.96, "10th_percentile": 511.08, "90th_percentile": 663.71, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "102", "median_amount": 711.37, "10th_percentile": 328.17, "90th_percentile": 770.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 644.35, "10th_percentile": 556.23, "90th_percentile": 733.77, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "115", "median_amount": 77.06, "10th_percentile": 74.24, "90th_percentile": 84.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "19", "median_amount": 229.79, "10th_percentile": 206.09, "90th_percentile": 241.30, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 227.47, "10th_percentile": 181.98, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "75", "median_amount": 227.47, "10th_percentile": 122.27, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 309.04, "90th_percentile": 717.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 309.04, "90th_percentile": 717.38, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 213.86, "10th_percentile": 187.13, "90th_percentile": 267.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 724.29, "10th_percentile": 608.40, "90th_percentile": 732.58, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 724.29, "10th_percentile": 608.40, "90th_percentile": 732.58, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iv infusion each add hr", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 60.20, "10th_percentile": 36.34, "90th_percentile": 117.66, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "23", "median_amount": 253.45, "10th_percentile": 123.27, "90th_percentile": 361.92, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 150.92, "10th_percentile": 143.57, "90th_percentile": 439.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 16.60, "10th_percentile": 15.09, "90th_percentile": 49.80, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 46.11, "10th_percentile": 44.96, "90th_percentile": 77.12, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.61, "10th_percentile": 35.61, "90th_percentile": 102.93, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 46.79, "10th_percentile": 44.52, "90th_percentile": 182.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 350.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 350.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.81, "10th_percentile": 40.32, "90th_percentile": 184.67, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther/proph/diag iv inf addon", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 60.20, "10th_percentile": 36.34, "90th_percentile": 117.66, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "23", "median_amount": 253.45, "10th_percentile": 123.27, "90th_percentile": 361.92, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 150.92, "10th_percentile": 143.57, "90th_percentile": 439.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 16.60, "10th_percentile": 15.09, "90th_percentile": 49.80, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 46.11, "10th_percentile": 44.96, "90th_percentile": 77.12, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.61, "10th_percentile": 35.61, "90th_percentile": 102.93, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 46.79, "10th_percentile": 44.52, "90th_percentile": 182.47, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 350.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 134.96, "10th_percentile": 134.96, "90th_percentile": 350.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.81, "10th_percentile": 40.32, "90th_percentile": 184.67, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv infusion sequential 1 hr", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 70.45, "10th_percentile": 56.93, "90th_percentile": 74.01, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 190.50, "10th_percentile": 165.42, "90th_percentile": 199.58, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 222.70, "10th_percentile": 222.70, "90th_percentile": 233.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 222.70, "10th_percentile": 222.70, "90th_percentile": 222.70, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 23.40, "10th_percentile": 23.40, "90th_percentile": 25.73, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "1 through 10", "median_amount": 73.27, "10th_percentile": 73.27, "90th_percentile": 73.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.06, "10th_percentile": 76.64, "90th_percentile": 137.47, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 72.53, "10th_percentile": 69.05, "90th_percentile": 72.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.10, "10th_percentile": 62.76, "90th_percentile": 80.01, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx/proph/dg addl seq iv inf", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 70.45, "10th_percentile": 56.93, "90th_percentile": 74.01, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 190.50, "10th_percentile": 165.42, "90th_percentile": 199.58, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 222.70, "10th_percentile": 222.70, "90th_percentile": 233.97, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 222.70, "10th_percentile": 222.70, "90th_percentile": 222.70, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 23.40, "10th_percentile": 23.40, "90th_percentile": 25.73, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "1 through 10", "median_amount": 73.27, "10th_percentile": 73.27, "90th_percentile": 73.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.06, "10th_percentile": 76.64, "90th_percentile": 137.47, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 72.53, "10th_percentile": 69.05, "90th_percentile": 72.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.10, "10th_percentile": 62.76, "90th_percentile": 80.01, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv infusion concurrent", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 71.00, "discounted_cash": 42.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.93, "10th_percentile": 18.42, "90th_percentile": 22.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 69.58, "10th_percentile": 66.15, "90th_percentile": 69.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.15, "10th_percentile": 66.15, "90th_percentile": 66.15, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 6.96, "10th_percentile": 6.96, "90th_percentile": 7.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.57, "10th_percentile": 20.72, "90th_percentile": 21.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.57, "10th_percentile": 20.52, "90th_percentile": 21.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.31, "10th_percentile": 17.48, "90th_percentile": 22.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 65.41, "10th_percentile": 65.41, "90th_percentile": 65.41, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 65.41, "10th_percentile": 65.41, "90th_percentile": 65.41, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ther/diag concurrent inf", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 71.00, "discounted_cash": 42.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.93, "10th_percentile": 18.42, "90th_percentile": 22.01, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 69.58, "10th_percentile": 66.15, "90th_percentile": 69.58, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 66.15, "10th_percentile": 66.15, "90th_percentile": 66.15, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 6.96, "10th_percentile": 6.96, "90th_percentile": 7.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.57, "10th_percentile": 20.72, "90th_percentile": 21.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.57, "10th_percentile": 20.52, "90th_percentile": 21.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.31, "10th_percentile": 17.48, "90th_percentile": 22.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 65.41, "10th_percentile": 65.41, "90th_percentile": 65.41, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 65.41, "10th_percentile": 65.41, "90th_percentile": 65.41, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iv infusion sq initial 1 hr", "code_information": [ { "code": "96369", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 238.87, "10th_percentile": 238.87, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "1 through 10", "median_amount": 241.30, "10th_percentile": 241.30, "90th_percentile": 241.30, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 181.98, "10th_percentile": 181.98, "90th_percentile": 186.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sc ther infusion up to 1 hr", "code_information": [ { "code": "96369", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 238.87, "10th_percentile": 238.87, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "1 through 10", "median_amount": 241.30, "10th_percentile": 241.30, "90th_percentile": 241.30, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 181.98, "10th_percentile": 181.98, "90th_percentile": 186.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv infusion sq ea addl hr", "code_information": [ { "code": "96370", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.79, "10th_percentile": 46.79, "90th_percentile": 46.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 47.26, "10th_percentile": 47.26, "90th_percentile": 47.26, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.61, "10th_percentile": 35.61, "90th_percentile": 37.16, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sc ther infusion addl hr", "code_information": [ { "code": "96370", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.79, "10th_percentile": 46.79, "90th_percentile": 46.79, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 47.26, "10th_percentile": 47.26, "90th_percentile": 47.26, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 35.61, "10th_percentile": 35.61, "90th_percentile": 37.16, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv infusion sq addl pump", "code_information": [ { "code": "96371", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sc ther infusion reset pump", "code_information": [ { "code": "96371", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injection sq or im diagnostic", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 274.17, "10th_percentile": 218.46, "90th_percentile": 329.87, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 274.17, "10th_percentile": 218.46, "90th_percentile": 329.87, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "72", "median_amount": 74.01, "10th_percentile": 56.36, "90th_percentile": 148.03, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "66", "median_amount": 189.82, "10th_percentile": 155.11, "90th_percentile": 206.08, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "128", "median_amount": 72.53, "10th_percentile": 55.23, "90th_percentile": 185.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 187.18, "10th_percentile": 79.10, "90th_percentile": 360.15, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "140", "median_amount": 24.50, "10th_percentile": 22.28, "90th_percentile": 27.61, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "29", "median_amount": 69.74, "10th_percentile": 69.74, "90th_percentile": 73.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 69.04, "10th_percentile": 55.23, "90th_percentile": 141.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "79", "median_amount": 69.05, "10th_percentile": 41.43, "90th_percentile": 138.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 93.82, "90th_percentile": 376.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 93.82, "90th_percentile": 376.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 64.94, "10th_percentile": 55.79, "90th_percentile": 81.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 206.64, "90th_percentile": 209.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 206.64, "90th_percentile": 209.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ther/proph/diag inj sc/im", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 274.17, "10th_percentile": 218.46, "90th_percentile": 329.87, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 274.17, "10th_percentile": 218.46, "90th_percentile": 329.87, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "72", "median_amount": 74.01, "10th_percentile": 56.36, "90th_percentile": 148.03, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "66", "median_amount": 189.82, "10th_percentile": 155.11, "90th_percentile": 206.08, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "128", "median_amount": 72.53, "10th_percentile": 55.23, "90th_percentile": 185.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 187.18, "10th_percentile": 79.10, "90th_percentile": 360.15, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "140", "median_amount": 24.50, "10th_percentile": 22.28, "90th_percentile": 27.61, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "29", "median_amount": 69.74, "10th_percentile": 69.74, "90th_percentile": 73.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 69.04, "10th_percentile": 55.23, "90th_percentile": 141.57, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "79", "median_amount": 69.05, "10th_percentile": 41.43, "90th_percentile": 138.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 93.82, "90th_percentile": 376.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 93.82, "90th_percentile": 376.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "29", "median_amount": 64.94, "10th_percentile": 55.79, "90th_percentile": 81.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 206.64, "90th_percentile": 209.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 209.34, "10th_percentile": 206.64, "90th_percentile": 209.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Injection intra-arterial diag", "code_information": [ { "code": "96373", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther/proph/diag inj ia", "code_information": [ { "code": "96373", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv push single or int drug", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 566.10, "10th_percentile": 260.51, "90th_percentile": 566.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 566.10, "10th_percentile": 260.51, "90th_percentile": 566.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 243.74, "10th_percentile": 232.11, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "112", "median_amount": 620.63, "10th_percentile": 456.14, "90th_percentile": 661.51, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "1 through 10", "median_amount": 463.06, "10th_percentile": 463.06, "90th_percentile": 463.06, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "194", "median_amount": 662.72, "10th_percentile": 625.97, "90th_percentile": 770.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 657.82, "10th_percentile": 625.97, "90th_percentile": 733.77, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "177", "median_amount": 77.06, "10th_percentile": 73.38, "90th_percentile": 84.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "33", "median_amount": 229.79, "10th_percentile": 141.79, "90th_percentile": 241.31, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 227.47, "10th_percentile": 162.49, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "145", "median_amount": 164.18, "10th_percentile": 116.37, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 396.64, "10th_percentile": 206.72, "90th_percentile": 656.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 396.64, "10th_percentile": 206.72, "90th_percentile": 656.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 208.76, "10th_percentile": 155.04, "90th_percentile": 267.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 611.30, "90th_percentile": 724.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 611.30, "90th_percentile": 724.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ther/proph/diag inj iv push", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 187.41, "maximum": 549.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 566.10, "10th_percentile": 260.51, "90th_percentile": 566.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 566.10, "10th_percentile": 260.51, "90th_percentile": 566.10, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 243.74, "10th_percentile": 232.11, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 549.47, "count": "112", "median_amount": 620.63, "10th_percentile": 456.14, "90th_percentile": 661.51, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 549.47, "count": "1 through 10", "median_amount": 463.06, "10th_percentile": 463.06, "90th_percentile": 463.06, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "194", "median_amount": 662.72, "10th_percentile": 625.97, "90th_percentile": 770.52, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 657.82, "10th_percentile": 625.97, "90th_percentile": 733.77, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "177", "median_amount": 77.06, "10th_percentile": 73.38, "90th_percentile": 84.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 187.41, "count": "33", "median_amount": 229.79, "10th_percentile": 141.79, "90th_percentile": 241.31, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 227.47, "10th_percentile": 162.49, "90th_percentile": 243.74, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "145", "median_amount": 164.18, "10th_percentile": 116.37, "90th_percentile": 238.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 396.64, "10th_percentile": 206.72, "90th_percentile": 656.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 396.64, "10th_percentile": 206.72, "90th_percentile": 656.65, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "56", "median_amount": 208.76, "10th_percentile": 155.04, "90th_percentile": 267.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 611.30, "90th_percentile": 724.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 689.75, "10th_percentile": 611.30, "90th_percentile": 724.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iv push ea add'l seq new drug", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 120.29, "10th_percentile": 112.76, "90th_percentile": 127.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 120.29, "10th_percentile": 112.76, "90th_percentile": 127.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 47.74, "10th_percentile": 36.52, "90th_percentile": 90.83, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "84", "median_amount": 129.57, "10th_percentile": 102.08, "90th_percentile": 345.12, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "1 through 10", "median_amount": 90.70, "10th_percentile": 90.70, "90th_percentile": 90.70, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "132", "median_amount": 150.92, "10th_percentile": 143.57, "90th_percentile": 450.56, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 150.92, "10th_percentile": 143.57, "90th_percentile": 452.76, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "160", "median_amount": 16.60, "10th_percentile": 15.09, "90th_percentile": 47.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "31", "median_amount": 47.26, "10th_percentile": 44.96, "90th_percentile": 134.88, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 46.79, "10th_percentile": 44.51, "90th_percentile": 95.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "121", "median_amount": 46.79, "10th_percentile": 44.52, "90th_percentile": 140.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.49, "10th_percentile": 89.72, "90th_percentile": 130.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.49, "10th_percentile": 89.72, "90th_percentile": 130.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 52.36, "10th_percentile": 39.85, "90th_percentile": 120.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.89, "10th_percentile": 118.47, "90th_percentile": 317.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.89, "10th_percentile": 118.47, "90th_percentile": 317.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tx/pro/dx inj new drug addon", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 120.29, "10th_percentile": 112.76, "90th_percentile": 127.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 120.29, "10th_percentile": 112.76, "90th_percentile": 127.82, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 47.74, "10th_percentile": 36.52, "90th_percentile": 90.83, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "84", "median_amount": 129.57, "10th_percentile": 102.08, "90th_percentile": 345.12, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "1 through 10", "median_amount": 90.70, "10th_percentile": 90.70, "90th_percentile": 90.70, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "132", "median_amount": 150.92, "10th_percentile": 143.57, "90th_percentile": 450.56, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 150.92, "10th_percentile": 143.57, "90th_percentile": 452.76, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "160", "median_amount": 16.60, "10th_percentile": 15.09, "90th_percentile": 47.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "31", "median_amount": 47.26, "10th_percentile": 44.96, "90th_percentile": 134.88, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 46.79, "10th_percentile": 44.51, "90th_percentile": 95.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "121", "median_amount": 46.79, "10th_percentile": 44.52, "90th_percentile": 140.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.49, "10th_percentile": 89.72, "90th_percentile": 130.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 113.49, "10th_percentile": 89.72, "90th_percentile": 130.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 52.36, "10th_percentile": 39.85, "90th_percentile": 120.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.89, "10th_percentile": 118.47, "90th_percentile": 317.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 143.89, "10th_percentile": 118.47, "90th_percentile": 317.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iv push each adl seq same drug", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 127.75, "discounted_cash": 76.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 39.60, "10th_percentile": 30.14, "90th_percentile": 79.21, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 125.19, "10th_percentile": 119.07, "90th_percentile": 245.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 187.79, "10th_percentile": 137.71, "90th_percentile": 237.87, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "116", "median_amount": 13.10, "10th_percentile": 12.52, "90th_percentile": 50.08, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.81, "10th_percentile": 29.54, "90th_percentile": 82.82, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "84", "median_amount": 38.81, "10th_percentile": 36.92, "90th_percentile": 116.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 69.50, "10th_percentile": 30.57, "90th_percentile": 131.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.68, "10th_percentile": 117.68, "90th_percentile": 117.68, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.68, "10th_percentile": 117.68, "90th_percentile": 117.68, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tx/pro/dx inj same drug adon", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 127.75, "discounted_cash": 76.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 39.60, "10th_percentile": 30.14, "90th_percentile": 79.21, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 125.19, "10th_percentile": 119.07, "90th_percentile": 245.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 187.79, "10th_percentile": 137.71, "90th_percentile": 237.87, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "116", "median_amount": 13.10, "10th_percentile": 12.52, "90th_percentile": 50.08, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.81, "10th_percentile": 29.54, "90th_percentile": 82.82, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "84", "median_amount": 38.81, "10th_percentile": 36.92, "90th_percentile": 116.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 69.50, "10th_percentile": 30.57, "90th_percentile": 131.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.68, "10th_percentile": 117.68, "90th_percentile": 117.68, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 117.68, "10th_percentile": 117.68, "90th_percentile": 117.68, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Application on-body injector", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Applicaton on-body injector", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Admn rsv monoc antb im njx", "code_information": [ { "code": "96381", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19.50, "discounted_cash": 11.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo anti neopl sq im", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.24, "10th_percentile": 55.24, "90th_percentile": 55.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.27, "10th_percentile": 77.27, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo anti-neopl sq/im", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.24, "10th_percentile": 55.24, "90th_percentile": 55.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.27, "10th_percentile": 77.27, "90th_percentile": 77.27, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo adm sq im horm anti neo", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.24, "10th_percentile": 55.24, "90th_percentile": 55.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.50, "10th_percentile": 63.76, "90th_percentile": 79.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo hormon antineopl sq/im", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 55.24, "10th_percentile": 55.24, "90th_percentile": 55.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.50, "10th_percentile": 63.76, "90th_percentile": 79.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv push sngl drug", "code_information": [ { "code": "96409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv push chemo sngl drug", "code_information": [ { "code": "96409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv push addl drug", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 196.58, "10th_percentile": 196.58, "90th_percentile": 196.58, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.01, "10th_percentile": 22.63, "90th_percentile": 25.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv infusion 1 hr", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "1 through 10", "median_amount": 1009.61, "10th_percentile": 1009.61, "90th_percentile": 1009.61, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1172.33, "10th_percentile": 633.70, "90th_percentile": 1200.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 114.37, "90th_percentile": 128.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "1 through 10", "median_amount": 376.11, "10th_percentile": 376.11, "90th_percentile": 376.11, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 363.42, "10th_percentile": 356.31, "90th_percentile": 370.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 372.32, "10th_percentile": 212.72, "90th_percentile": 372.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Infusion chemo iv 1 hr", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "1 through 10", "median_amount": 1009.61, "10th_percentile": 1009.61, "90th_percentile": 1009.61, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1172.33, "10th_percentile": 633.70, "90th_percentile": 1200.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.23, "10th_percentile": 114.37, "90th_percentile": 128.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "1 through 10", "median_amount": 376.11, "10th_percentile": 376.11, "90th_percentile": 376.11, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 363.42, "10th_percentile": 356.31, "90th_percentile": 370.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 372.32, "10th_percentile": 212.72, "90th_percentile": 372.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv infusion addl hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 393.18, "10th_percentile": 393.18, "90th_percentile": 393.18, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 467.95, "10th_percentile": 378.65, "90th_percentile": 467.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.28, "10th_percentile": 22.28, "90th_percentile": 22.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.98, "10th_percentile": 41.43, "90th_percentile": 94.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv infusion chemo addl hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 393.18, "10th_percentile": 393.18, "90th_percentile": 393.18, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 467.95, "10th_percentile": 378.65, "90th_percentile": 467.95, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.28, "10th_percentile": 22.28, "90th_percentile": 22.28, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 56.98, "10th_percentile": 41.43, "90th_percentile": 94.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv infus each addl seq", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 196.58, "10th_percentile": 196.58, "90th_percentile": 196.58, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 350.96, "10th_percentile": 257.37, "90th_percentile": 444.55, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.40, "10th_percentile": 22.50, "90th_percentile": 25.26, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.53, "10th_percentile": 72.53, "90th_percentile": 72.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv infusion chemo ea addl seq", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 238.75, "discounted_cash": 143.25, "minimum": 63.31, "maximum": 185.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 185.61, "count": "1 through 10", "median_amount": 196.58, "10th_percentile": 196.58, "90th_percentile": 196.58, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 185.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 350.96, "10th_percentile": 257.37, "90th_percentile": 444.55, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.40, "10th_percentile": 22.50, "90th_percentile": 25.26, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 63.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.53, "10th_percentile": 72.53, "90th_percentile": 72.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo adm cns req spinal punct", "code_information": [ { "code": "96450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemotherapy into cns", "code_information": [ { "code": "96450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Irrig drug delivery device", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.16, "10th_percentile": 33.16, "90th_percentile": 33.16, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "1 through 10", "median_amount": 171.43, "10th_percentile": 171.43, "90th_percentile": 171.43, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.01, "10th_percentile": 52.01, "90th_percentile": 102.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.97, "10th_percentile": 20.97, "90th_percentile": 20.97, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "1 through 10", "median_amount": 62.54, "10th_percentile": 62.54, "90th_percentile": 62.54, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.90, "10th_percentile": 61.90, "90th_percentile": 64.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.76, "10th_percentile": 72.76, "90th_percentile": 72.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Irrigation implanted vad", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 128.40, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 33.16, "10th_percentile": 33.16, "90th_percentile": 33.16, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "1 through 10", "median_amount": 171.43, "10th_percentile": 171.43, "90th_percentile": 171.43, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.01, "10th_percentile": 52.01, "90th_percentile": 102.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.97, "10th_percentile": 20.97, "90th_percentile": 20.97, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "1 through 10", "median_amount": 62.54, "10th_percentile": 62.54, "90th_percentile": 62.54, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.90, "10th_percentile": 61.90, "90th_percentile": 64.08, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.76, "10th_percentile": 72.76, "90th_percentile": 72.76, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemotherapy injection", "code_information": [ { "code": "96542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 786.25, "discounted_cash": 471.75, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemotherapy unspecified", "code_information": [ { "code": "96549", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mechanical traction therapy", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.25, "discounted_cash": 62.55, "minimum": 13.40, "maximum": 39.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 39.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 39.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.15, "10th_percentile": 30.15, "90th_percentile": 68.99, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.70, "10th_percentile": 10.70, "90th_percentile": 10.70, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mechanical traction", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.25, "discounted_cash": 62.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.91, "10th_percentile": 30.15, "90th_percentile": 57.00, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.22, "10th_percentile": 10.22, "90th_percentile": 10.22, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.17, "10th_percentile": 22.17, "90th_percentile": 22.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 15.45, "10th_percentile": 15.45, "90th_percentile": 15.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 15.45, "10th_percentile": 15.45, "90th_percentile": 15.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.45, "10th_percentile": 15.45, "90th_percentile": 15.45, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 69.13, "10th_percentile": 62.97, "90th_percentile": 75.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 69.13, "10th_percentile": 62.97, "90th_percentile": 75.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Electric stimulation therapy", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.75, "discounted_cash": 28.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot e-stim unattended", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.75, "discounted_cash": 28.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrical stimulation unatten", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.75, "discounted_cash": 28.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vasopneumatic device therapy", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.50, "discounted_cash": 27.90, "minimum": 10.88, "maximum": 31.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 31.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 31.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 10.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vasopneumatic devices", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.50, "discounted_cash": 27.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Paraffin bath therapy", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.75, "discounted_cash": 13.65, "minimum": 5.66, "maximum": 16.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 16.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 16.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot paraffin bath", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.75, "discounted_cash": 13.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Paraffin bath", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.75, "discounted_cash": 13.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diathermy eg microwave", "code_information": [ { "code": "97024", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.25, "discounted_cash": 16.35, "minimum": 6.48, "maximum": 19.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 19.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 19.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diathermy eg microwave 1+ area", "code_information": [ { "code": "97024", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.25, "discounted_cash": 16.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diathermy eg microwave 1+ area", "code_information": [ { "code": "97024", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.25, "discounted_cash": 16.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrical stimulation", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.50, "discounted_cash": 34.50, "minimum": 13.40, "maximum": 39.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 39.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 39.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electric stim manual each 15", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.50, "discounted_cash": 34.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electric current therapy", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.75, "discounted_cash": 45.45, "minimum": 17.31, "maximum": 50.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 50.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 50.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 17.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iontophoresis each 15 min", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.75, "discounted_cash": 45.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Contrast bath therapy", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.75, "discounted_cash": 34.05, "minimum": 12.67, "maximum": 37.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Contrast bath each 15 min", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.75, "discounted_cash": 34.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ultrasound therapy", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55.75, "discounted_cash": 33.45, "minimum": 12.95, "maximum": 37.97, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot ultrasound ea 15 min", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55.75, "discounted_cash": 33.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ultrasound each 15 min", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 55.75, "discounted_cash": 33.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5.47, "10th_percentile": 5.47, "90th_percentile": 5.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapeutic exercises", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.25, "discounted_cash": 83.55, "minimum": 26.71, "maximum": 78.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 158.46, "10th_percentile": 125.33, "90th_percentile": 191.59, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 158.46, "10th_percentile": 125.33, "90th_percentile": 191.59, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 61.34, "10th_percentile": 41.08, "90th_percentile": 93.23, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 78.31, "count": "13", "median_amount": 209.32, "10th_percentile": 89.18, "90th_percentile": 234.32, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 78.31, "count": "1 through 10", "median_amount": 293.78, "10th_percentile": 293.78, "90th_percentile": 293.78, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 84.61, "10th_percentile": 41.00, "90th_percentile": 126.91, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 101.05, "10th_percentile": 84.88, "90th_percentile": 117.22, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "53", "median_amount": 15.01, "10th_percentile": 8.26, "90th_percentile": 40.94, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.71, "count": "1 through 10", "median_amount": 51.33, "10th_percentile": 51.33, "90th_percentile": 51.33, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.41, "10th_percentile": 64.41, "90th_percentile": 64.41, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 84.62, "10th_percentile": 38.27, "90th_percentile": 98.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.05, "10th_percentile": 45.05, "90th_percentile": 45.05, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 205.25, "10th_percentile": 205.24, "90th_percentile": 307.86, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 205.25, "10th_percentile": 205.24, "90th_percentile": 307.86, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot therapeutic proc ea 15 min", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.25, "discounted_cash": 83.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.29, "10th_percentile": 14.29, "90th_percentile": 14.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapy procedure each 15 min", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.25, "discounted_cash": 83.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 65.72, "10th_percentile": 34.54, "90th_percentile": 106.74, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "44", "median_amount": 50.31, "10th_percentile": 5.96, "90th_percentile": 120.77, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.41, "10th_percentile": 47.53, "90th_percentile": 108.52, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 27.29, "10th_percentile": 13.65, "90th_percentile": 32.21, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.17, "10th_percentile": 3.17, "90th_percentile": 77.92, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 50.32, "10th_percentile": 29.62, "90th_percentile": 67.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 74.69, "10th_percentile": 46.22, "90th_percentile": 117.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 195.30, "10th_percentile": 195.30, "90th_percentile": 285.35, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 195.30, "10th_percentile": 195.30, "90th_percentile": 285.35, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neuromuscular reeducation", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 133.00, "discounted_cash": 79.80, "minimum": 29.69, "maximum": 87.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.47, "10th_percentile": 36.28, "90th_percentile": 62.67, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 87.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 87.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.27, "10th_percentile": 27.27, "90th_percentile": 27.27, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 29.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "St neuro re-ed ea 15 min", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 133.00, "discounted_cash": 79.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot neuro re-ed ea 15 min", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 133.00, "discounted_cash": 79.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.91, "10th_percentile": 26.91, "90th_percentile": 26.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neuro re-ed pnf each 15 min", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 133.00, "discounted_cash": 79.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 62.74, "10th_percentile": 62.74, "90th_percentile": 62.74, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.11, "10th_percentile": 6.11, "90th_percentile": 44.14, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.27, "10th_percentile": 19.03, "90th_percentile": 39.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.91, "10th_percentile": 26.91, "90th_percentile": 26.91, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aquatic therapy/exercises", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.75, "discounted_cash": 85.05, "minimum": 33.46, "maximum": 98.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 98.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 98.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 33.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aguatic therapy exercise ea 15", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.75, "discounted_cash": 85.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aquatic therapy exercise ea 15", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.75, "discounted_cash": 85.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 75.47, "10th_percentile": 70.21, "90th_percentile": 80.72, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 74.09, "10th_percentile": 72.26, "90th_percentile": 75.93, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gait training therapy", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.75, "discounted_cash": 90.45, "minimum": 26.71, "maximum": 78.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.05, "10th_percentile": 37.38, "90th_percentile": 46.73, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 78.31, "count": "1 through 10", "median_amount": 96.59, "10th_percentile": 96.59, "90th_percentile": 96.59, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 78.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 14.78, "10th_percentile": 8.95, "90th_percentile": 29.55, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.73, "10th_percentile": 46.73, "90th_percentile": 46.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 34.88, "10th_percentile": 5.02, "90th_percentile": 67.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.26, "10th_percentile": 51.26, "90th_percentile": 51.26, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gait training each 15 min", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.75, "discounted_cash": 90.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.61, "10th_percentile": 38.26, "90th_percentile": 79.45, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.70, "10th_percentile": 11.50, "90th_percentile": 46.89, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.47, "10th_percentile": 15.06, "90th_percentile": 15.94, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.61, "10th_percentile": 43.61, "90th_percentile": 82.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 78.06, "10th_percentile": 78.06, "90th_percentile": 78.06, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Massage therapy", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.75, "discounted_cash": 68.25, "minimum": 27.10, "maximum": 79.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 79.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 79.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Massage ea 15 min", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.75, "discounted_cash": 68.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "St cognitive skills devel", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.75, "discounted_cash": 62.25, "minimum": 20.58, "maximum": 60.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 60.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 60.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 20.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther ivntj 1st 15 min", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.75, "discounted_cash": 62.25, "minimum": 20.58, "maximum": 60.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 60.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 60.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 20.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "St ther ivnt cog func 1st 15 m", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 55.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot ther ivnt cog func 1st 15 m", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 55.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther ivntj ea addl 15 min", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1.75, "discounted_cash": 1.05, "minimum": 19.94, "maximum": 58.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 58.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 58.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "St ther ivnt cog func ea + 15", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1.75, "discounted_cash": 1.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GN", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot ther ivnt cog func ea + 15", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1.75, "discounted_cash": 1.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Manual therapy 1/> regions", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 106.25, "discounted_cash": 63.75, "minimum": 25.24, "maximum": 73.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.41, "10th_percentile": 6.23, "90th_percentile": 32.59, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 73.99, "count": "1 through 10", "median_amount": 89.40, "10th_percentile": 83.88, "90th_percentile": 89.40, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 73.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.28, "10th_percentile": 32.28, "90th_percentile": 32.28, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 25.24, "count": "1 through 10", "median_amount": 6.00, "10th_percentile": 6.00, "90th_percentile": 23.50, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot manual therapy ea 15 min", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 106.25, "discounted_cash": 63.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Manual therapy tech each 15", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 106.25, "discounted_cash": 63.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.35, "10th_percentile": 25.57, "90th_percentile": 30.30, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.45, "10th_percentile": 24.00, "90th_percentile": 32.28, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.46, "10th_percentile": 10.61, "90th_percentile": 11.46, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.49, "10th_percentile": 21.49, "90th_percentile": 21.49, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.23, "10th_percentile": 14.52, "90th_percentile": 15.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Group therapeutic procedures", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.25, "discounted_cash": 41.55, "minimum": 16.34, "maximum": 47.89, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 47.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 47.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 16.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot therapeutic proc grp", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.25, "discounted_cash": 41.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt therapeutic procedure group", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.25, "discounted_cash": 41.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval low complex 20 min", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "minimum": 91.05, "maximum": 266.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 266.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 266.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 91.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval low complex 20 min", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.10, "10th_percentile": 82.44, "90th_percentile": 85.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 85.88, "10th_percentile": 70.12, "90th_percentile": 101.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.38, "10th_percentile": 80.38, "90th_percentile": 80.38, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 34.05, "10th_percentile": 32.42, "90th_percentile": 37.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.43, "10th_percentile": 74.71, "90th_percentile": 105.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.15, "10th_percentile": 94.17, "90th_percentile": 112.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval mod complex 30 min", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 390.50, "discounted_cash": 234.30, "minimum": 91.05, "maximum": 266.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 266.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 266.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.07, "10th_percentile": 40.07, "90th_percentile": 40.07, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 91.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval mod complex 30 min", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 390.50, "discounted_cash": 234.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 351.45, "10th_percentile": 351.45, "90th_percentile": 351.45, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 351.45, "10th_percentile": 351.45, "90th_percentile": 351.45, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 96.85, "10th_percentile": 92.19, "90th_percentile": 121.06, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 98.24, "10th_percentile": 78.64, "90th_percentile": 118.64, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 38.27, "10th_percentile": 38.27, "90th_percentile": 40.07, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 90.35, "10th_percentile": 84.78, "90th_percentile": 110.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 90.35, "10th_percentile": 78.89, "90th_percentile": 118.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 200.27, "10th_percentile": 130.27, "90th_percentile": 270.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 200.27, "10th_percentile": 130.27, "90th_percentile": 270.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 112.77, "10th_percentile": 106.40, "90th_percentile": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval high complex 45 min", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 417.00, "discounted_cash": 250.20, "minimum": 91.05, "maximum": 266.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 266.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 266.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 91.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval high complex 45 min", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 417.00, "discounted_cash": 250.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 337.77, "10th_percentile": 337.77, "90th_percentile": 337.77, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 337.77, "10th_percentile": 337.77, "90th_percentile": 337.77, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 99.27, "10th_percentile": 99.27, "90th_percentile": 99.27, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 110.98, "10th_percentile": 87.36, "90th_percentile": 126.68, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.49, "10th_percentile": 96.49, "90th_percentile": 96.49, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.80, "10th_percentile": 41.83, "90th_percentile": 43.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 96.49, "10th_percentile": 96.49, "90th_percentile": 96.49, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 86.31, "10th_percentile": 84.43, "90th_percentile": 126.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 121.78, "10th_percentile": 114.98, "90th_percentile": 133.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt re-eval est plan care", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.50, "discounted_cash": 125.10, "minimum": 62.23, "maximum": 182.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 182.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 182.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 62.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt re-eval est plan care", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.50, "discounted_cash": 125.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.94, "10th_percentile": 45.10, "90th_percentile": 48.77, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 60.31, "10th_percentile": 48.49, "90th_percentile": 63.35, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.61, "10th_percentile": 63.61, "90th_percentile": 63.61, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 20.84, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.05, "10th_percentile": 29.05, "90th_percentile": 29.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.49, "10th_percentile": 54.21, "90th_percentile": 70.21, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 153.66, "10th_percentile": 153.66, "90th_percentile": 153.66, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 153.66, "10th_percentile": 153.66, "90th_percentile": 153.66, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot eval low complex 30 min", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "minimum": 93.26, "maximum": 273.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 273.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 273.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 93.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval low complex 30 min", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.50, "discounted_cash": 208.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 82.02, "10th_percentile": 82.02, "90th_percentile": 82.02, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.05, "10th_percentile": 31.24, "90th_percentile": 35.65, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 80.38, "10th_percentile": 80.38, "90th_percentile": 80.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 92.98, "10th_percentile": 82.90, "90th_percentile": 103.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 112.46, "10th_percentile": 112.46, "90th_percentile": 112.46, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval mod complex 45 min", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.75, "discounted_cash": 236.25, "minimum": 93.26, "maximum": 273.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 273.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 273.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 93.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval mod complex 45 min", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.75, "discounted_cash": 236.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 116.25, "10th_percentile": 101.37, "90th_percentile": 120.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 485.53, "10th_percentile": 485.53, "90th_percentile": 485.53, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.59, "10th_percentile": 38.59, "90th_percentile": 39.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.62, "10th_percentile": 119.62, "90th_percentile": 119.62, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval high complex 60 min", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 428.50, "discounted_cash": 257.10, "minimum": 93.26, "maximum": 273.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 273.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 273.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 93.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval high complex 60 min", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 428.50, "discounted_cash": 257.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot re-eval est plan care", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.50, "discounted_cash": 125.10, "minimum": 64.04, "maximum": 187.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 187.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 187.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 64.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot re-eval est plan care", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.50, "discounted_cash": 125.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapeutic activities", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.75, "discounted_cash": 90.45, "minimum": 31.63, "maximum": 92.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 44.49, "10th_percentile": 37.38, "90th_percentile": 44.49, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 92.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 92.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.10, "10th_percentile": 45.80, "90th_percentile": 52.40, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 17.88, "10th_percentile": 8.95, "90th_percentile": 32.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 31.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.88, "10th_percentile": 34.88, "90th_percentile": 34.88, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot therapeutic activity 15 min", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.75, "discounted_cash": 90.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 46.73, "10th_percentile": 46.73, "90th_percentile": 46.73, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 98.20, "10th_percentile": 98.20, "90th_percentile": 98.20, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.51, "10th_percentile": 16.88, "90th_percentile": 28.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 69.76, "10th_percentile": 69.76, "90th_percentile": 69.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapeutic active each 15min", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.75, "discounted_cash": 90.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.94, "10th_percentile": 36.48, "90th_percentile": 60.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.80, "10th_percentile": 44.04, "90th_percentile": 78.91, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.78, "10th_percentile": 14.49, "90th_percentile": 21.10, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 45.80, "10th_percentile": 37.06, "90th_percentile": 45.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.79, "10th_percentile": 48.79, "90th_percentile": 50.77, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sensory integration", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.50, "discounted_cash": 144.30, "minimum": 53.90, "maximum": 158.02, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 158.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 158.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 53.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sensory integration ea 15 min", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.50, "discounted_cash": 144.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Self care mngment training", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "minimum": 29.46, "maximum": 86.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 42.78, "10th_percentile": 42.78, "90th_percentile": 111.23, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 86.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 86.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.59, "10th_percentile": 8.59, "90th_percentile": 15.47, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 29.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot self care train ea 15 min", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.09, "10th_percentile": 25.41, "90th_percentile": 42.78, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.88, "10th_percentile": 14.34, "90th_percentile": 25.71, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 88.11, "10th_percentile": 88.11, "90th_percentile": 88.11, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Self care home mgmt trn 15 min", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Community/work reintegration", "code_information": [ { "code": "97537", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "minimum": 29.32, "maximum": 85.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 85.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 85.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 29.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot community re-integ 15 min", "code_information": [ { "code": "97537", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wheelchair mngment training", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "minimum": 28.49, "maximum": 83.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 83.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 83.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 28.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot wheelchair management ea 15", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wheelchair mgmt each 15 min", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 74.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Work hardening", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Work hardening initial 2 hr", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.50, "discounted_cash": 155.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Work hardening add-on", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 103.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Work cond each addn hr", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 103.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rmvl devital tis 20 cm/<", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 586.43, "discounted_cash": 351.86, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.34, "10th_percentile": 117.71, "90th_percentile": 254.48, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 54.52, "10th_percentile": 54.52, "90th_percentile": 54.52, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 107.56, "10th_percentile": 107.56, "90th_percentile": 107.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rmvl devital tis addl 20cm/<", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 556.00, "discounted_cash": 333.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound(s) care non-selective", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 662.65, "discounted_cash": 397.59, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 94.27, "10th_percentile": 94.27, "90th_percentile": 94.27, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 127.10, "10th_percentile": 117.71, "90th_percentile": 154.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 52.07, "10th_percentile": 52.07, "90th_percentile": 52.07, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "1 through 10", "median_amount": 163.05, "10th_percentile": 163.05, "90th_percentile": 163.05, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 107.56, "10th_percentile": 107.56, "90th_percentile": 112.98, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg press wound tx <=50 cm", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 584.91, "discounted_cash": 350.95, "minimum": 176.75, "maximum": 518.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 518.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.34, "10th_percentile": 119.34, "90th_percentile": 119.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 176.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg press wound tx >50 cm", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg prs wnd ther dme>50 sqcm", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg press wnd tx <=50 sq cm", "code_information": [ { "code": "97607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg prs wnd ther <50sq disps", "code_information": [ { "code": "97607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg press wound tx >50 cm", "code_information": [ { "code": "97608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg prs wnd ther <50sq disps", "code_information": [ { "code": "97608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1022.00, "discounted_cash": 613.20, "minimum": 355.39, "maximum": 1041.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1041.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 355.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Physical performance test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.50, "discounted_cash": 77.70, "minimum": 30.57, "maximum": 89.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 89.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 89.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 30.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Physical perform tst w rpt 15", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.50, "discounted_cash": 77.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Physical perform tst w rpt 15", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.50, "discounted_cash": 77.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orthotic mgmt&traing 1st enc", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 203.25, "discounted_cash": 121.95, "minimum": 41.56, "maximum": 121.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 121.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 121.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot orthot mng extr init 15min", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 203.25, "discounted_cash": 121.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt orthotic management ea 15", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 203.25, "discounted_cash": 121.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.91, "10th_percentile": 21.91, "90th_percentile": 21.91, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orthc/prostc mgmt sbsq enc", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 184.75, "discounted_cash": 110.85, "minimum": 45.05, "maximum": 132.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 132.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 132.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.91, "10th_percentile": 19.91, "90th_percentile": 19.91, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 45.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orthc/prostc mgmt sbsq 15min", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 184.75, "discounted_cash": 110.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orthotic prosth mgmt ea 15 min", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 184.75, "discounted_cash": 110.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Medical nutrition indiv in", "code_information": [ { "code": "97802", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 97.25, "discounted_cash": 58.35, "minimum": 29.26, "maximum": 85.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 85.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 85.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 29.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mnt int assessment ea 15 min", "code_information": [ { "code": "97802", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 97.25, "discounted_cash": 58.35, "minimum": 29.26, "maximum": 85.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 85.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 85.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 29.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Med nutrition indiv subseq", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.75, "discounted_cash": 52.65, "minimum": 24.77, "maximum": 72.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 24.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mnt ind re-assess ea 15 min", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.75, "discounted_cash": 52.65, "minimum": 24.77, "maximum": 72.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 24.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Medical nutrition group", "code_information": [ { "code": "97804", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.75, "discounted_cash": 29.85, "minimum": 13.95, "maximum": 40.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mnt grp ea 30 min", "code_information": [ { "code": "97804", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.75, "discounted_cash": 29.85, "minimum": 13.95, "maximum": 40.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Osteopath manj 1-2 regions", "code_information": [ { "code": "98925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.75, "discounted_cash": 61.65, "minimum": 22.50, "maximum": 65.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 65.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 65.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 22.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Osteopathic man 1-2 body reg", "code_information": [ { "code": "98925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.75, "discounted_cash": 61.65, "minimum": 22.50, "maximum": 65.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 65.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 65.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 22.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Special anes serv <1 or >70", "code_information": [ { "code": "99100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.50, "discounted_cash": 113.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Special anesthesia service", "code_information": [ { "code": "99100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.50, "discounted_cash": 113.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Conscious sedation <5 yrs int", "code_information": [ { "code": "99151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 89.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 38.56, "10th_percentile": 38.56, "90th_percentile": 38.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 38.56, "10th_percentile": 38.56, "90th_percentile": 38.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed same phys/qhp <5 yrs", "code_information": [ { "code": "99151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 89.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 38.56, "10th_percentile": 38.56, "90th_percentile": 38.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 38.56, "10th_percentile": 38.56, "90th_percentile": 38.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Conscious sedation age 5+ 1st", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 127.75, "discounted_cash": 76.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed same phys/qhp 5/>yrs", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 127.75, "discounted_cash": 76.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Conscious sedation ea addl 15", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.75, "discounted_cash": 22.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 9.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 9.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed same phys/qhp ea", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.75, "discounted_cash": 22.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 9.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 9.52, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phlebotomy", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.39, "10th_percentile": 104.39, "90th_percentile": 104.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.91, "10th_percentile": 117.91, "90th_percentile": 117.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phlebotomy therapeutic", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 433.50, "discounted_cash": 260.10, "minimum": 114.66, "maximum": 336.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 104.39, "10th_percentile": 104.39, "90th_percentile": 104.39, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 117.91, "10th_percentile": 117.91, "90th_percentile": 117.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Consult new op visit 15 min", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.25, "discounted_cash": 97.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.03, "10th_percentile": 5.79, "90th_percentile": 6.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.89, "10th_percentile": 19.89, "90th_percentile": 19.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.25, "discounted_cash": 97.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.03, "10th_percentile": 5.79, "90th_percentile": 6.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.89, "10th_percentile": 19.89, "90th_percentile": 19.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99203", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 272.50, "discounted_cash": 163.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.93, "10th_percentile": 7.10, "90th_percentile": 65.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.64, "10th_percentile": 15.04, "90th_percentile": 15.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.99, "10th_percentile": 24.99, "90th_percentile": 24.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.71, "10th_percentile": 67.71, "90th_percentile": 67.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.71, "10th_percentile": 67.71, "90th_percentile": 67.71, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pro new op visit 30 min", "code_information": [ { "code": "99203", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 272.50, "discounted_cash": 163.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.93, "10th_percentile": 7.10, "90th_percentile": 65.03, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.64, "10th_percentile": 15.04, "90th_percentile": 15.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.99, "10th_percentile": 24.99, "90th_percentile": 24.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.71, "10th_percentile": 67.71, "90th_percentile": 67.71, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 67.71, "10th_percentile": 67.71, "90th_percentile": 67.71, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.75, "discounted_cash": 263.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.70, "10th_percentile": 23.70, "90th_percentile": 23.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.99, "10th_percentile": 105.92, "90th_percentile": 114.06, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.44, "10th_percentile": 17.44, "90th_percentile": 17.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound care new op visit 45 min", "code_information": [ { "code": "99204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.75, "discounted_cash": 263.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.70, "10th_percentile": 23.70, "90th_percentile": 23.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 109.99, "10th_percentile": 105.92, "90th_percentile": 114.06, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.44, "10th_percentile": 17.44, "90th_percentile": 17.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Telepsych est op visit 45 min", "code_information": [ { "code": "99204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 220.00, "discounted_cash": 132.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Consult new op visit 60 min", "code_information": [ { "code": "99205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 361.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.57, "10th_percentile": 19.57, "90th_percentile": 19.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 361.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.57, "10th_percentile": 19.57, "90th_percentile": 19.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.25, "discounted_cash": 21.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Onc est op pt visit nurse", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36.25, "discounted_cash": 21.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99212", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.50, "discounted_cash": 71.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.90, "10th_percentile": 12.90, "90th_percentile": 12.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5.09, "10th_percentile": 4.90, "90th_percentile": 5.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.16, "10th_percentile": 11.06, "90th_percentile": 15.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.68, "10th_percentile": 17.00, "90th_percentile": 17.68, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pro est op visit 10 min", "code_information": [ { "code": "99212", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.50, "discounted_cash": 71.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.90, "10th_percentile": 12.90, "90th_percentile": 12.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5.09, "10th_percentile": 4.90, "90th_percentile": 5.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.16, "10th_percentile": 11.06, "90th_percentile": 15.27, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.68, "10th_percentile": 17.00, "90th_percentile": 17.68, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.00, "discounted_cash": 130.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 55.35, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 55.35, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.69, "10th_percentile": 18.69, "90th_percentile": 18.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.78, "10th_percentile": 17.78, "90th_percentile": 45.47, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 6.31, "10th_percentile": 6.03, "90th_percentile": 15.64, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.07, "10th_percentile": 19.07, "90th_percentile": 19.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 13.09, "10th_percentile": 12.45, "90th_percentile": 18.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.91, "10th_percentile": 20.40, "90th_percentile": 20.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pro est op visit 20 min", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.00, "discounted_cash": 130.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 55.35, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 55.35, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.69, "10th_percentile": 18.69, "90th_percentile": 18.69, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.78, "10th_percentile": 17.78, "90th_percentile": 45.47, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 6.31, "10th_percentile": 6.03, "90th_percentile": 15.64, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.07, "10th_percentile": 19.07, "90th_percentile": 19.07, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 13.09, "10th_percentile": 12.45, "90th_percentile": 18.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.91, "10th_percentile": 20.40, "90th_percentile": 20.91, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 317.25, "discounted_cash": 190.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.60, "10th_percentile": 22.60, "90th_percentile": 22.60, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.96, "10th_percentile": 18.18, "90th_percentile": 21.74, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.87, "10th_percentile": 7.53, "90th_percentile": 76.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.74, "10th_percentile": 22.29, "90th_percentile": 23.20, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.25, "10th_percentile": 15.93, "90th_percentile": 23.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.10, "10th_percentile": 26.10, "90th_percentile": 26.10, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pro est op visit 30 min", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 317.25, "discounted_cash": 190.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.60, "10th_percentile": 22.60, "90th_percentile": 22.60, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.96, "10th_percentile": 18.18, "90th_percentile": 21.74, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.87, "10th_percentile": 7.53, "90th_percentile": 76.28, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.74, "10th_percentile": 22.29, "90th_percentile": 23.20, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.25, "10th_percentile": 15.93, "90th_percentile": 23.32, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.10, "10th_percentile": 26.10, "90th_percentile": 26.10, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Telepsych est op visit 30 min", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.75, "discounted_cash": 95.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 471.50, "discounted_cash": 282.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pro est op visit 40 min", "code_information": [ { "code": "99215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 471.50, "discounted_cash": 282.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Telepsych est op visit 40 min", "code_information": [ { "code": "99215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 235.75, "discounted_cash": 141.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Initial hospital care", "code_information": [ { "code": "99221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 277.00, "discounted_cash": 166.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip intl hosp care low 40 min", "code_information": [ { "code": "99221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 277.00, "discounted_cash": 166.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Initial hospital care", "code_information": [ { "code": "99222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.75, "discounted_cash": 225.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 105.73, "10th_percentile": 105.73, "90th_percentile": 106.35, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip intl hosp care mod 55 min", "code_information": [ { "code": "99222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.75, "discounted_cash": 225.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 105.73, "10th_percentile": 105.73, "90th_percentile": 106.35, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Initial hospital care", "code_information": [ { "code": "99223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 550.50, "discounted_cash": 330.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip intl hosp care mod 75 min", "code_information": [ { "code": "99223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 550.50, "discounted_cash": 330.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip sbsq hosp care low 25 min", "code_information": [ { "code": "99231", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 109.00, "discounted_cash": 65.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Subsequent hospital care", "code_information": [ { "code": "99231", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 109.00, "discounted_cash": 65.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip sbsq hosp care mod 35 min", "code_information": [ { "code": "99232", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 196.75, "discounted_cash": 118.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 63.51, "10th_percentile": 63.51, "90th_percentile": 66.41, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Subsequent hospital care", "code_information": [ { "code": "99232", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 196.75, "discounted_cash": 118.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 63.51, "10th_percentile": 63.51, "90th_percentile": 66.41, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip sbsq hosp care high 50 min", "code_information": [ { "code": "99233", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 281.75, "discounted_cash": 169.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Subsequent hospital care", "code_information": [ { "code": "99233", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 281.75, "discounted_cash": 169.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs sm dt low 45 min", "code_information": [ { "code": "99234", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 374.50, "discounted_cash": 224.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Observ/hosp same date", "code_information": [ { "code": "99234", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 374.50, "discounted_cash": 224.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs hosp sm dt mod 70 min", "code_information": [ { "code": "99235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 292.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.02, "10th_percentile": 129.02, "90th_percentile": 129.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Observ/hosp same date", "code_information": [ { "code": "99235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 292.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.02, "10th_percentile": 129.02, "90th_percentile": 129.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs hosp sm dt hi 85 min", "code_information": [ { "code": "99236", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 606.00, "discounted_cash": 363.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Observ/hosp same date", "code_information": [ { "code": "99236", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 606.00, "discounted_cash": 363.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital discharge day", "code_information": [ { "code": "99238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.75, "discounted_cash": 116.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 66.56, "10th_percentile": 66.56, "90th_percentile": 67.54, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs hosp discharge mgmt30/<", "code_information": [ { "code": "99238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.75, "discounted_cash": 116.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 66.56, "10th_percentile": 66.56, "90th_percentile": 67.54, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital discharge day", "code_information": [ { "code": "99239", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 284.75, "discounted_cash": 170.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs hosp discharge mgmt>30", "code_information": [ { "code": "99239", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 284.75, "discounted_cash": 170.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office consultation", "code_information": [ { "code": "99242", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 340.25, "discounted_cash": 204.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Op consult new est pt 30 min", "code_information": [ { "code": "99242", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 340.25, "discounted_cash": 204.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office consultation", "code_information": [ { "code": "99243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 465.50, "discounted_cash": 279.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Op cnslt new/est low 30 min", "code_information": [ { "code": "99243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 465.50, "discounted_cash": 279.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office consultation", "code_information": [ { "code": "99244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 708.00, "discounted_cash": 424.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Op cnslt new/est mod 40 min", "code_information": [ { "code": "99244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 708.00, "discounted_cash": 424.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office consultation", "code_information": [ { "code": "99245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 863.00, "discounted_cash": 517.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Op cnslt new/est hi 55 min", "code_information": [ { "code": "99245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 863.00, "discounted_cash": 517.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inpatient consultation", "code_information": [ { "code": "99252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 296.25, "discounted_cash": 177.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs conslt new/est sf35min", "code_information": [ { "code": "99252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 296.25, "discounted_cash": 177.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inpatient consultation", "code_information": [ { "code": "99253", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 275.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs conslt new/est low45min", "code_information": [ { "code": "99253", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 275.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inpatient consultation", "code_information": [ { "code": "99254", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 670.50, "discounted_cash": 402.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs conslt new/est mod60min", "code_information": [ { "code": "99254", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 670.50, "discounted_cash": 402.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inpatient consultation", "code_information": [ { "code": "99255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 805.00, "discounted_cash": 483.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ip/obs conslt new/est hi80min", "code_information": [ { "code": "99255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 805.00, "discounted_cash": 483.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 318.50, "discounted_cash": 191.10, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.70, "10th_percentile": 129.70, "90th_percentile": 129.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.21, "10th_percentile": 31.21, "90th_percentile": 31.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency room minimal", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 318.50, "discounted_cash": 191.10, "minimum": 78.32, "maximum": 229.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 229.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 129.70, "10th_percentile": 129.70, "90th_percentile": 129.70, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 31.21, "10th_percentile": 31.21, "90th_percentile": 31.21, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 78.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 521.25, "discounted_cash": 312.75, "minimum": 140.86, "maximum": 413.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 469.13, "10th_percentile": 469.13, "90th_percentile": 469.13, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 469.13, "10th_percentile": 469.13, "90th_percentile": 469.13, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.48, "10th_percentile": 44.90, "90th_percentile": 123.17, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 413.00, "count": "21", "median_amount": 343.44, "10th_percentile": 48.48, "90th_percentile": 417.51, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 45.66, "10th_percentile": 42.99, "90th_percentile": 89.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 51.09, "10th_percentile": 51.09, "90th_percentile": 55.65, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.86, "count": "1 through 10", "median_amount": 32.47, "10th_percentile": 30.47, "90th_percentile": 34.47, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.01, "10th_percentile": 131.42, "90th_percentile": 148.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 45.66, "10th_percentile": 30.96, "90th_percentile": 134.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 159.50, "10th_percentile": 145.32, "90th_percentile": 173.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 480.18, "10th_percentile": 480.18, "90th_percentile": 480.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 480.18, "10th_percentile": 480.18, "90th_percentile": 480.18, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emergency room brief", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 521.25, "discounted_cash": 312.75, "minimum": 140.86, "maximum": 413.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 469.13, "10th_percentile": 469.13, "90th_percentile": 469.13, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 469.13, "10th_percentile": 469.13, "90th_percentile": 469.13, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.48, "10th_percentile": 44.90, "90th_percentile": 123.17, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 413.00, "count": "21", "median_amount": 343.44, "10th_percentile": 48.48, "90th_percentile": 417.51, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 45.66, "10th_percentile": 42.99, "90th_percentile": 89.49, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 51.09, "10th_percentile": 51.09, "90th_percentile": 55.65, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 140.86, "count": "1 through 10", "median_amount": 32.47, "10th_percentile": 30.47, "90th_percentile": 34.47, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 140.01, "10th_percentile": 131.42, "90th_percentile": 148.61, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 45.66, "10th_percentile": 30.96, "90th_percentile": 134.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 159.50, "10th_percentile": 145.32, "90th_percentile": 173.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 480.18, "10th_percentile": 480.18, "90th_percentile": 480.18, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 480.18, "10th_percentile": 480.18, "90th_percentile": 480.18, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 926.25, "discounted_cash": 555.75, "minimum": 246.30, "maximum": 722.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 793.80, "10th_percentile": 704.97, "90th_percentile": 821.68, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 793.80, "10th_percentile": 704.97, "90th_percentile": 821.68, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 273.42, "10th_percentile": 163.14, "90th_percentile": 287.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 722.12, "count": "73", "median_amount": 593.68, "10th_percentile": 327.86, "90th_percentile": 715.87, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 722.12, "count": "1 through 10", "median_amount": 742.10, "10th_percentile": 742.10, "90th_percentile": 742.10, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 281.40, "10th_percentile": 130.89, "90th_percentile": 438.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 205.69, "10th_percentile": 151.07, "90th_percentile": 280.84, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "91", "median_amount": 86.44, "10th_percentile": 64.13, "90th_percentile": 95.08, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 246.30, "count": "1 through 10", "median_amount": 159.27, "10th_percentile": 145.69, "90th_percentile": 249.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 214.37, "10th_percentile": 160.64, "90th_percentile": 287.14, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 161.98, "10th_percentile": 146.31, "90th_percentile": 280.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.97, "10th_percentile": 291.75, "90th_percentile": 610.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.97, "10th_percentile": 291.75, "90th_percentile": 610.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 230.18, "10th_percentile": 67.59, "90th_percentile": 251.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 650.00, "10th_percentile": 418.90, "90th_percentile": 812.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 650.00, "10th_percentile": 418.90, "90th_percentile": 812.50, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emergency room intermediate", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 926.25, "discounted_cash": 555.75, "minimum": 246.30, "maximum": 722.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 793.80, "10th_percentile": 704.97, "90th_percentile": 821.68, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 793.80, "10th_percentile": 704.97, "90th_percentile": 821.68, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "22", "median_amount": 273.42, "10th_percentile": 163.14, "90th_percentile": 287.14, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 722.12, "count": "73", "median_amount": 593.68, "10th_percentile": 327.86, "90th_percentile": 715.87, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 722.12, "count": "1 through 10", "median_amount": 742.10, "10th_percentile": 742.10, "90th_percentile": 742.10, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "49", "median_amount": 281.40, "10th_percentile": 130.89, "90th_percentile": 438.87, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 205.69, "10th_percentile": 151.07, "90th_percentile": 280.84, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "91", "median_amount": 86.44, "10th_percentile": 64.13, "90th_percentile": 95.08, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 246.30, "count": "1 through 10", "median_amount": 159.27, "10th_percentile": 145.69, "90th_percentile": 249.27, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 214.37, "10th_percentile": 160.64, "90th_percentile": 287.14, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 161.98, "10th_percentile": 146.31, "90th_percentile": 280.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.97, "10th_percentile": 291.75, "90th_percentile": 610.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 450.97, "10th_percentile": 291.75, "90th_percentile": 610.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 230.18, "10th_percentile": 67.59, "90th_percentile": 251.94, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 650.00, "10th_percentile": 418.90, "90th_percentile": 812.50, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 650.00, "10th_percentile": 418.90, "90th_percentile": 812.50, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1470.50, "discounted_cash": 882.30, "minimum": 378.77, "maximum": 1110.53, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1091.11, "10th_percentile": 466.23, "90th_percentile": 1279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1091.11, "10th_percentile": 466.23, "90th_percentile": 1279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 434.08, "10th_percentile": 424.85, "90th_percentile": 455.86, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1110.53, "count": "97", "median_amount": 1001.40, "10th_percentile": 605.87, "90th_percentile": 1221.73, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1110.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "86", "median_amount": 597.20, "10th_percentile": 175.33, "90th_percentile": 1325.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 456.79, "10th_percentile": 83.05, "90th_percentile": 1283.63, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "156", "median_amount": 144.11, "10th_percentile": 108.34, "90th_percentile": 150.95, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 378.77, "count": "1 through 10", "median_amount": 341.30, "10th_percentile": 315.24, "90th_percentile": 436.21, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 425.40, "10th_percentile": 340.31, "90th_percentile": 455.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "75", "median_amount": 376.40, "10th_percentile": 317.60, "90th_percentile": 446.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 754.34, "10th_percentile": 404.75, "90th_percentile": 1234.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 754.34, "10th_percentile": 404.75, "90th_percentile": 1234.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 380.87, "10th_percentile": 241.41, "90th_percentile": 499.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 872.27, "10th_percentile": 551.25, "90th_percentile": 1044.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 872.27, "10th_percentile": 551.25, "90th_percentile": 1044.16, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emergency room extended", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1470.50, "discounted_cash": 882.30, "minimum": 378.77, "maximum": 1110.53, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1091.11, "10th_percentile": 466.23, "90th_percentile": 1279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1091.11, "10th_percentile": 466.23, "90th_percentile": 1279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 434.08, "10th_percentile": 424.85, "90th_percentile": 455.86, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1110.53, "count": "97", "median_amount": 1001.40, "10th_percentile": 605.87, "90th_percentile": 1221.73, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1110.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "86", "median_amount": 597.20, "10th_percentile": 175.33, "90th_percentile": 1325.82, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 456.79, "10th_percentile": 83.05, "90th_percentile": 1283.63, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "156", "median_amount": 144.11, "10th_percentile": 108.34, "90th_percentile": 150.95, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 378.77, "count": "1 through 10", "median_amount": 341.30, "10th_percentile": 315.24, "90th_percentile": 436.21, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 425.40, "10th_percentile": 340.31, "90th_percentile": 455.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "75", "median_amount": 376.40, "10th_percentile": 317.60, "90th_percentile": 446.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 754.34, "10th_percentile": 404.75, "90th_percentile": 1234.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 754.34, "10th_percentile": 404.75, "90th_percentile": 1234.57, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 380.87, "10th_percentile": 241.41, "90th_percentile": 499.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 872.27, "10th_percentile": 551.25, "90th_percentile": 1044.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 872.27, "10th_percentile": 551.25, "90th_percentile": 1044.16, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2199.50, "discounted_cash": 1319.70, "minimum": 545.36, "maximum": 1598.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1682.62, "10th_percentile": 1445.07, "90th_percentile": 1920.16, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1682.62, "10th_percentile": 1445.07, "90th_percentile": 1920.16, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "87", "median_amount": 681.85, "10th_percentile": 545.48, "90th_percentile": 681.85, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1598.95, "count": "147", "median_amount": 1573.02, "10th_percentile": 1237.58, "90th_percentile": 1850.61, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1598.95, "count": "1 through 10", "median_amount": 1295.43, "10th_percentile": 1295.43, "90th_percentile": 1295.43, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 652.31, "10th_percentile": 639.57, "90th_percentile": 665.04, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "293", "median_amount": 1671.75, "10th_percentile": 589.93, "90th_percentile": 2084.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 1945.05, "10th_percentile": 658.23, "90th_percentile": 2155.51, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "322", "median_amount": 215.55, "10th_percentile": 205.29, "90th_percentile": 237.11, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 545.36, "count": "62", "median_amount": 550.03, "10th_percentile": 517.88, "90th_percentile": 671.81, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 636.38, "10th_percentile": 626.05, "90th_percentile": 681.85, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "230", "median_amount": 636.39, "10th_percentile": 528.59, "90th_percentile": 668.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1757.81, "10th_percentile": 558.73, "90th_percentile": 2026.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1757.81, "10th_percentile": 558.73, "90th_percentile": 2026.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "96", "median_amount": 598.26, "10th_percentile": 523.48, "90th_percentile": 712.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1929.68, "10th_percentile": 1637.99, "90th_percentile": 2034.87, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1929.68, "10th_percentile": 1637.99, "90th_percentile": 2034.87, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emergency room comprehensive", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2199.50, "discounted_cash": 1319.70, "minimum": 545.36, "maximum": 1598.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1682.62, "10th_percentile": 1445.07, "90th_percentile": 1920.16, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1682.62, "10th_percentile": 1445.07, "90th_percentile": 1920.16, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "87", "median_amount": 681.85, "10th_percentile": 545.48, "90th_percentile": 681.85, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1598.95, "count": "147", "median_amount": 1573.02, "10th_percentile": 1237.58, "90th_percentile": 1850.61, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1598.95, "count": "1 through 10", "median_amount": 1295.43, "10th_percentile": 1295.43, "90th_percentile": 1295.43, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 652.31, "10th_percentile": 639.57, "90th_percentile": 665.04, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "293", "median_amount": 1671.75, "10th_percentile": 589.93, "90th_percentile": 2084.61, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 1945.05, "10th_percentile": 658.23, "90th_percentile": 2155.51, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "322", "median_amount": 215.55, "10th_percentile": 205.29, "90th_percentile": 237.11, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 545.36, "count": "62", "median_amount": 550.03, "10th_percentile": 517.88, "90th_percentile": 671.81, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 636.38, "10th_percentile": 626.05, "90th_percentile": 681.85, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "230", "median_amount": 636.39, "10th_percentile": 528.59, "90th_percentile": 668.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1757.81, "10th_percentile": 558.73, "90th_percentile": 2026.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1757.81, "10th_percentile": 558.73, "90th_percentile": 2026.18, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "96", "median_amount": 598.26, "10th_percentile": 523.48, "90th_percentile": 712.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1929.68, "10th_percentile": 1637.99, "90th_percentile": 2034.87, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1929.68, "10th_percentile": 1637.99, "90th_percentile": 2034.87, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Critical care 30-74 min er tc", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2862.75, "discounted_cash": 1717.65, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "1 through 10", "median_amount": 2408.64, "10th_percentile": 2408.64, "90th_percentile": 2408.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 873.00, "10th_percentile": 480.25, "90th_percentile": 1265.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 280.55, "10th_percentile": 181.52, "90th_percentile": 295.36, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 869.71, "10th_percentile": 840.68, "90th_percentile": 869.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Critical care first hour", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2862.75, "discounted_cash": 1717.65, "minimum": 749.51, "maximum": 2197.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2197.50, "count": "1 through 10", "median_amount": 2408.64, "10th_percentile": 2408.64, "90th_percentile": 2408.64, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2197.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 873.00, "10th_percentile": 480.25, "90th_percentile": 1265.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 280.55, "10th_percentile": 181.52, "90th_percentile": 295.36, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 749.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 869.71, "10th_percentile": 840.68, "90th_percentile": 869.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Critical care addl 30 min", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 336.50, "discounted_cash": 201.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.37, "10th_percentile": 4.37, "90th_percentile": 4.37, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care init", "code_information": [ { "code": "99304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 263.00, "discounted_cash": 157.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care int low", "code_information": [ { "code": "99304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 263.00, "discounted_cash": 157.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care init", "code_information": [ { "code": "99305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 368.00, "discounted_cash": 220.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care int med", "code_information": [ { "code": "99305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 368.00, "discounted_cash": 220.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care init", "code_information": [ { "code": "99306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.50, "discounted_cash": 281.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care int high", "code_information": [ { "code": "99306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.50, "discounted_cash": 281.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing fac care subseq", "code_information": [ { "code": "99307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.75, "discounted_cash": 74.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care sub low", "code_information": [ { "code": "99307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.75, "discounted_cash": 74.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing fac care subseq", "code_information": [ { "code": "99308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 192.25, "discounted_cash": 115.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care sub med", "code_information": [ { "code": "99308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 192.25, "discounted_cash": 115.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing fac care subseq", "code_information": [ { "code": "99309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 251.50, "discounted_cash": 150.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care sub mod", "code_information": [ { "code": "99309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 251.50, "discounted_cash": 150.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing fac care subseq", "code_information": [ { "code": "99310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.25, "discounted_cash": 223.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility care sub high", "code_information": [ { "code": "99310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 373.25, "discounted_cash": 223.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing fac discharge day", "code_information": [ { "code": "99315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 182.75, "discounted_cash": 109.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility dc <30 min", "code_information": [ { "code": "99315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 182.75, "discounted_cash": 109.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing fac discharge day", "code_information": [ { "code": "99316", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 236.25, "discounted_cash": 141.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nursing facility dc > 30 min", "code_information": [ { "code": "99316", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 236.25, "discounted_cash": 141.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Behav chng smoking 3-10 min", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 46.80, "minimum": 26.50, "maximum": 77.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tobacco cess cnslng 3-10 min", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 46.80, "minimum": 26.50, "maximum": 77.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Behav chng smoking > 10 min", "code_information": [ { "code": "99407", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 46.80, "minimum": 26.50, "maximum": 77.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tobacco cess cnslng >10 min", "code_information": [ { "code": "99407", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 46.80, "minimum": 26.50, "maximum": 77.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 77.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tracheostomy care kit", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 96.25, "discounted_cash": 57.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.67, "10th_percentile": 89.67, "90th_percentile": 89.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ventilator sterile tube", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 96.25, "discounted_cash": 57.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 89.67, "10th_percentile": 89.67, "90th_percentile": 89.67, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thera tears", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "58790000115", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 80.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glycerine supp", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "58980041012a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Oxycontin 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59011041020", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 36.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Oxycontin 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59011042020", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 67.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Samsca 15mg tab", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59148002050", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1075.00, "discounted_cash": 645.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dilantin 100 mg cap", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "57664080888a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tears naturale 15 ml", "drug_information": { "unit": 270.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "57896018105a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mag-ox 400mg tablet", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "57896063412a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Robitussin syrup 118 ml", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "57896069316a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Calcium carbonate 600mg tab", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "57896074606", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fluconazole 10mg/ml oral susp", "drug_information": { "unit": 350.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "57237014935a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 49.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amoxicillin 250mg cap", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "57237003001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ivabradine 7.5 mg tab", "drug_information": { "unit": 7.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "55513081060", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glucophage 500 mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687015501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mamantine 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687018411a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 71.00, "discounted_cash": 42.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cardizem cd 120 mg tab", "drug_information": { "unit": 120.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687019501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Meloxicam 15 mg tab", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687019901a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 27.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cardizem cd 180 mg tab", "drug_information": { "unit": 180.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687020601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sertraline 100 mg tablet", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687025301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Raloxifene 60mg tab", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687026621a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 42.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ceftin 250 mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687027211a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42.00, "discounted_cash": 25.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenytoin 100mg/4ml oral susp", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687027562a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 49.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aricept 10 mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687030311a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zyvox 600 mg tablet", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687030921a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 202.00, "discounted_cash": 121.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Capoten 25 mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687031511a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lisinopril 10mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687032501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Seroquel 25mg tablet", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687032701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sevelamer carbonate 800 mg tab", "drug_information": { "unit": 800.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687032833a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 35.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lisinopril 20mg tablet", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687033301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Seroquel 100mg tablet", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687034901a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 37.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Midodrine 2.5 mg tablet", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687038701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Toprol xl 25 mg", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687039001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Actos 15mg", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687039111a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Toprol xl 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687040201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Midodrine hcl 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687040925A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocodone-acetamin 7.5-325", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687041744A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 51.00, "discounted_cash": 30.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocodon acetaminphen 10/325", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687041811A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Warfarin 7.5mg tablet", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687042865a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Elavil 25 mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687043301A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Celecoxib 100mg cap", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687043611a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Normodyne 200 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687043911a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Desyrel 50mg tablet", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687044301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pregabalin lyrica 25 mg cap", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687047311A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 97.00, "discounted_cash": 58.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Flagyl 250 mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687052601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Febuxostat 40 mg tab", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687053821a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 17.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rifamin 300mg capsule", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687058601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neurontin 300mg tablet", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687059101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pepcid 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687059511a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bactrim ds tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687061411A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fenofibrate 145 mg tab", "drug_information": { "unit": 145.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687062911a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bystolic 5 mg tablet", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687064111A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 34.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Levetiracetam 500mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687065711a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenobarb 20 mg elix 5ml", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687067140a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methimazole 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687068011a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nateglinide 120 mg tab", "drug_information": { "unit": 120.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687068421b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cardizem 30 mg vd tab", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687071711a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cardizem 60 mg tab", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687072811A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Antivert 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687073001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glipizide er 2.5 mg", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687076811a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ultram 50 mg tab", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687079501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Digoxin .125 mg tab", "drug_information": { "unit": 0.13, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687085811a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Estradiol 1 mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687087611a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glucotrol xl 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687088111A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aldomet 250mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62135032190a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 86.00, "discounted_cash": 51.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neomycin 500 mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62135044390a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Atarax syrup 10mg/5ml", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62135050247a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 36.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Oxybutynin chloride er 10 tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62175027137", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 18.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Slobid 300 mg", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62332002531A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Catapres 0.1 mg tab", "drug_information": { "unit": 0.10, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62332005431a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Leflunomide 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62332006230a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 94.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Propafenone hci 150 mg tab", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62559023001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vibramycin 100 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62584069321A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 32.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Metformin hcl 500mg ter", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62756014202a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ondansetron 4mg odt", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62756024064", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Carbidopa levodopa 50 200 tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62756045788", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sinemet 10/100 tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62756051788a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Carbidopa levodopa 25/250mg", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62756051988a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aricept 23 mg tab", "drug_information": { "unit": 23.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "62856024730A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pilocarpine 1% opth sol 15 ml", "drug_information": { "unit": 270.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314020315", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 946.00, "discounted_cash": 567.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Timolol 0.5% gfs solution 5ml", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314022505", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 417.00, "discounted_cash": 250.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Timoptic oph 0.5% 5ml", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314022705", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xalaton 0.005% 2.5ml ophtalmic", "drug_information": { "unit": 45.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314054701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 98.00, "discounted_cash": 58.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neodecadron oph s 0.1% 5 ml", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314063006", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 50.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neodecadron oph oint 3.5 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314063136", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 121.00, "discounted_cash": 72.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prednisolone acetate ophth sus", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314063705A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 63.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cortisporin ot/sol 10 ml", "drug_information": { "unit": 180.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314064511a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 528.00, "discounted_cash": 316.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ciloxan 0.3% opth drops", "drug_information": { "unit": 90.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61314065605", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emticitabine tenofovir 100mg", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "61958070101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 88.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Liothyronine sod 0.005mg tab", "drug_information": { "unit": 0.01, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60793011501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Thrombin bovine topical 5000", "drug_information": { "unit": 5000.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60793021505A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 727.00, "discounted_cash": 436.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Thrombin top 10.000u", "drug_information": { "unit": 20000.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60793021720", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2869.00, "discounted_cash": 1721.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zetia 10 mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59651005230a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 99.00, "discounted_cash": 59.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Compazine 5 mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59746011306a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hytrin 5mg po", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59746038506a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lomotil tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59762106101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zoloft 50 mg tab", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59762490003", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Azulfidine 500mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "59762500006A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phosnak 1 packet", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60258000601A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Trental 400 mg cap", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505003306A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Paxil 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505008302", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gabapentin 400mg cap", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505011407A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pravastatin 10mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505016809A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 18.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ddavp demopressin acet 0.1 tab", "drug_information": { "unit": 0.10, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505025701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 17.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Desmopressin acetate 0.2mg tab", "drug_information": { "unit": 0.20, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505025801A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42.00, "discounted_cash": 25.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Travoprost eye sol 0.004% 2.5m", "drug_information": { "unit": 45.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505059304a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36221.00, "discounted_cash": 21732.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pravastatin sodium 80mg tab", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505132309a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 27.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Leflunomide 10mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505250201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 94.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Maxide tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505265701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aripiprazole 5 mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505267303", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 95.00, "discounted_cash": 57.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Olanzapine odt 5 mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505327503a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 137.00, "discounted_cash": 82.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Effient 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505464303A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 94.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Atropine sulfate 1% opth sol", "drug_information": { "unit": 90.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60505622600a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 560.00, "discounted_cash": 336.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Azilsartan med/chlorth tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60631041230", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 51.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Edarbyclor 40/25 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60631042530", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 51.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Anastrozole 1mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687011221a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Colace 100 mg cap", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687012901a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glucophage 850 mg tab", "drug_information": { "unit": 850.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "60687014301A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Kayexalate 60 ml", "drug_information": { "unit": 15.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46287000660", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bicalutamide 50 mg tablet", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "47335048583A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Niacin 500 mg er tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "47335053981", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fentanyl 12 mcg/hr patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "47781042347a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 195.00, "discounted_cash": 117.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mineral oil 30 ml", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "48433020230a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Biotene mouth rinse 473 ml", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "48582000330", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 56.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Calcitonin salmon 200 un nasal", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "49884016111A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1138.00, "discounted_cash": 682.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Azithromycin 250 mg", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50111078710a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ecotrin tab", "drug_information": { "unit": 325.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122059602a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aspirin ec 81 mg", "drug_information": { "unit": 81.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122059848a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hemorrhodial relief ointment", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122067746a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocortisone 2.5% cream 28gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802000403", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mycostatin ointment 15 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802004835", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bacitracin oint 1 oz", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802006003", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 16.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bacitracin ud oint packet", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802006070", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Triamcinolone crm 0.1% 16 oz", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802006405A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mesalamine 4gm/60ml enema", "drug_information": { "unit": 4.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802009851A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 139.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bactroban oint 30gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802011222", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 61.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Afrin spray 15ml", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802041059a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acetaminophen 10 gr supp", "drug_information": { "unit": 650.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802073032a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acetamin 120 mg sup", "drug_information": { "unit": 120.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "45802073230a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Permethrin 1% lotion 60ml", "drug_information": { "unit": 60.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122010846A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 66.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tylenol elixer 4 oz", "drug_information": { "unit": 160.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122032226a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Habitrol 7 mg patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122035474a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 20.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neosporin oint 1 oz", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122041403a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mintox 12 oz bottle", "drug_information": { "unit": 355.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "46122043340a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrogen peroxide 8 oz", "drug_information": { "unit": 240.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50804087134a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Periactin 4 mg tab", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50742019001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Procardia xl 30 mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50742026001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vitamin d3 1000 unit tab", "drug_information": { "unit": 1000.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268086615a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tucks pads 40", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50289325001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Invokana 100 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50458014030A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 115.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xarelto 10mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50458058010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 196.00, "discounted_cash": 117.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Santyl 250 units/gm oint 30gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50484001030A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 242.00, "discounted_cash": 145.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Naprosyn 250 mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268059415A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Macrodantin 50 mg cap", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268062311a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pravastation 40mg", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268066715a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rosuvastatin 40mg tab", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268071111a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ropinirole 0.25mg tab", "drug_information": { "unit": 0.25, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268074115", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acetazolamide 25o mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268005411A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Baclofen 10 mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268010615a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bumex 1 mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268013111A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Buspirone 15mg", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268013515", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Flexeril 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268019111a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fenofibrate 160mg tab", "drug_information": { "unit": 160.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268031315a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 29.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glucotrol 5 mg", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268036111a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vistaril 25 mg cap", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "50268039850a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lamotrigine 200 mg tab", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "55111072030a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sumatriptan 6mg/0.5ml inj", "drug_information": { "unit": 6.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "55150017301A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 67.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dificid 200 mg tab", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "52015008001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2498.00, "discounted_cash": 1498.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vaseline 1 oz", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "53329006801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Minoxidil 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "53489038701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pentasa 500 mg cr capsule", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "54092019112A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Solifenacin succinate 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51248015001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 123.00, "discounted_cash": 73.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenazopyradine 100mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51293081001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Thiamine 100 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51645090501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ferrous sulfate elixir 473 ml", "drug_information": { "unit": 220.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "54838000180a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Haloperidol lactate 2mg oral", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "54838050115a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glimepiride 2mg tablet", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "55111032101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fenofibrate 43 mg", "drug_information": { "unit": 43.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "55111034930", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ammonium lactate 12% cream", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672130100", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tolnaftate 1% crm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672202002", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Monistat 7 vag c 47 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672203506", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acetamin 325 mg sup", "drug_information": { "unit": 325.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672211604a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nortriptyline 25mg cap", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672400201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nortriptyline 75mg cap", "drug_information": { "unit": 75.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672400401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tegretol 200 mg tab", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672400501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Clotrimazole betamethas1% .05%", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672404801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mycolog cream 30 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672126302a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 55.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Kenalog/orab ps 5 gm 0.1%", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672126705", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mycolog ointment 15 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672127201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 39.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nystatin cream", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51672128901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lopressor 50 mg tab", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079080120", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Buspirone 5mg tablet", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079098520A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zaroxyln 5 mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079002401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydralazine 10mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079007401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aldactone 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079010320", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chlordiazepioxide 25 mg cap", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079014120", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cipro 500 mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079018201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Allopurinol 100mg tablet", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079020501A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zyloprim 300 mg tab", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079020620", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Metoprolol tartrate 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079025520", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valium 2 mg tab", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079028401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Diazepam 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079028520", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valium 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079028620", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chlordiazepoxide 10mg capsule", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079037520", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sinequan 25 mg cap", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079043720", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tenormin 50 mg tab", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079068420", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Carafate 1 gm tab", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079075320", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Atenolo 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "51079075920", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidocaine 5% ointment", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462041827A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 73.00, "discounted_cash": 43.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Colesevelam hcl 625mg tablet", "drug_information": { "unit": 625.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462043318a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 22.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fenofibrate 134mg cap", "drug_information": { "unit": 134.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462058101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rasagiline mesylate 0.5mg tab", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68546014256A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 526.00, "discounted_cash": 315.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zofran 8mg tablet", "drug_information": { "unit": 8.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462015811A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ropinirole hci 1 mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462025501B", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Calan sr 240 mg tab", "drug_information": { "unit": 240.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462026001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aggrenox 200mg/25mg capsule", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462040560a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Indocin 25 mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68462040601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Flomax 0.4mg cap", "drug_information": { "unit": 0.40, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084029901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lamotrigine 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084031801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amaryl 4 mg tab", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084032701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cozaar 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084034601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Losartan 50mg tablet", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084034701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cordarone 200 mg", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084037101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cogentin 2 mg tab", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084038911a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ms contin 15 mg tab", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084040301A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tacrolimus 1 mg", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084045001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 25.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Plavix 75 mg", "drug_information": { "unit": 75.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084053601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 67.00, "discounted_cash": 40.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Perphenazine 4mg tab", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084060201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lexapro 20mg tablet", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084061801A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 26.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bupropion hcl sr 100 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084069701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bupropion hcl sr 150 mg tab", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084070825a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Venlafaxine 75mg cap", "drug_information": { "unit": 75.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084070901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zyprexa 5 mg tablet", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084072311A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Diflucan 100 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084072801A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tizanidine 2 mg tab", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084077525a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cardura 2 mg tab", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084085195a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sirolimus 1 mg tablet", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084091525A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 98.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Morphine sulfate 10 mg/0.5 ml", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68094004558A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Megestrol acetate 40mg/ml", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68094006362a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 19.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tylenol elixer one dose", "drug_information": { "unit": 160.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68094023162a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Motrin elixir one dose", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68094049461", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dekas plus chewable multi vit", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68176000015", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Simvastatin 40 mg tablet", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68180046409a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 28.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Simvastatin 20 mg tablet", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68180047902a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 28.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Oseltamivir phosphate 30mg cap", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68180067511a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 136.00, "discounted_cash": 81.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cefdinir 250 mg/5ml bottle", "drug_information": { "unit": 3000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68180072305A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 231.00, "discounted_cash": 138.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Haloperidol 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68382007901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Topiramate 50 mg tablet", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68382013914A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 29.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Symmetrel 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68382051201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mesalamine 1.2g tablet", "drug_information": { "unit": 1.20, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68382071119a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 97.00, "discounted_cash": 58.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Budesibude 3mg cap dr", "drug_information": { "unit": 3.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68382072001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nateglinide 60 mg tablet", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68382072116A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cleocin sp 75 mg/5ml 100 ml", "drug_information": { "unit": 1500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65862059602A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 595.00, "discounted_cash": 357.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fenofibrate 48mg tab", "drug_information": { "unit": 48.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65862076890a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sodium bicarbonate 650mg table", "drug_information": { "unit": 650.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "66553000801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prazosin 1 mg cap", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "66993043185a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Silvadene cream 400 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "67877012440A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 282.00, "discounted_cash": 169.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Silvadene cream 50 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "67877012450A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 70.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Restoril 15 mg cap", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "67877014601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Restoril 30 mg cap", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "67877014701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ezetimibe simvastation tablet", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "67877050930a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Benzonatate 200mg cap", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "67877057501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 27.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Catapres 0.2 mg tab", "drug_information": { "unit": 0.20, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68001023800a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Depakote 250 mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68001047300a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Biaxin 500mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68002010402a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Isordil 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084008311A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Atorvastatin 10mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084009701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Atorvastatin 40mg tablet", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084009901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mirtazapine 30mg tab", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084012001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Promethazine 25 mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084015501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Azathioprine 50mg tab", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084022901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cleocin 150 mg cap", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084024301A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Claritin 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084024801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydroxychloroquine 200 mg tab", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084026901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42.00, "discounted_cash": 25.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Risperidone 0.5mg tablet", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084027101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Risperdal 1 mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68084027201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 26.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acetylcysteine 6000mg 30ml 20%", "drug_information": { "unit": 6000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "63323069030a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 285.00, "discounted_cash": 171.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methazolamide 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "63629198701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 126.00, "discounted_cash": 75.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Caldesene powder 142g", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "63736011151", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Colcrys 0.6mg tab", "drug_information": { "unit": 0.60, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "64764011907", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ramelteon 8 mg tab", "drug_information": { "unit": 8.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "64764080530A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 125.00, "discounted_cash": 75.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cocaine 4ml topical", "drug_information": { "unit": 4.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "64950036204A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2352.00, "discounted_cash": 1411.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenobarbital 32.4 mg tab", "drug_information": { "unit": 32.40, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "64950057401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Alendronate sodium 70mg", "drug_information": { "unit": 70.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "64980034214a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cefpodoxime proxetil 50mg/5ml", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "64980040350a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 827.00, "discounted_cash": 496.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Coumadin 1mg tablet", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65162076110a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Jantoven (warfirin)2.5mg tab", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65162076310a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Warfarin 3mg tablet", "drug_information": { "unit": 3.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65162076410a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Warfarin 4mg tablet", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65162076510a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Coumadin 5 mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65162076610a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Warfarin 7.5mg tablet", "drug_information": { "unit": 7.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65162076810a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Coumadin 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65162076910a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rifaximin 550 mg tab", "drug_information": { "unit": 550.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65649030303", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 587.00, "discounted_cash": 352.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mirtazapine 30mg tablet", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65862002206A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ambien 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65862016001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 29.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Altace 2.5mg", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "65862047501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Reno capsule", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "63044062201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fibercon", "drug_information": { "unit": 625.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00005250033", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Raltegravir potassium 400mg ta", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00006022761", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 64.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Januvia 100 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00006027731", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 63.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tamiflu", "drug_information": { "unit": 75.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00004080085", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 87.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tamiflu 6mg/ml oral susp 60ml", "drug_information": { "unit": 360.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00004082205A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 168.00, "discounted_cash": 100.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Baricitinib 2mg tab", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00002418230", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 912.00, "discounted_cash": 547.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Humalog (novolog) insulin inj", "drug_information": { "unit": 1.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00002751001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Humalog 75/25 insulin inj", "drug_information": { "unit": 1.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00002751101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bmx suspension (oral susp)", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00000000003", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dulaglutide 1.5mg/0.5ml", "drug_information": { "unit": 1.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00002143480", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2417.00, "discounted_cash": 1450.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Insulin regular; one dose", "drug_information": { "unit": 1.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00002821501A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Novolin n insulin dose", "drug_information": { "unit": 1.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00002831501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Insulin 70/30; one dose", "drug_information": { "unit": 1.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00002871501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Eliquis 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00003089431", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Protonix 40 mg packet", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00008084401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 167.00, "discounted_cash": 100.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Colestipol hci 1 gm tablet", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00009045003A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Refresh pm eye ointment", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023066704a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Refresh tears 15 ml bottle", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023079815", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 81.00, "discounted_cash": 48.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Restasis eye drops", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023916330", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 61.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Refresh liquigel 15ml opthalmi", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023920515A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Brimonidine/timolol 0.2%/0.5%", "drug_information": { "unit": 90.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023921110", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35275.00, "discounted_cash": 21165.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Brimonidine 0.1% ophthalmic so", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023932105A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 373.00, "discounted_cash": 223.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Flecainide 50mg tab", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054001021", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Flecainide acetate 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054001121", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 20.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prednisone 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054001720", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prednisone 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054001820", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ipatropium bromide 0.06% nasal", "drug_information": { "unit": 165.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054004641", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10107.00, "discounted_cash": 6064.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Calcium acetate 667mg cap", "drug_information": { "unit": 667.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054008826", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Azelastine hcl 137 mcg nas spr", "drug_information": { "unit": 200.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054029399", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 20.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Advair diskus 50/100", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054032656A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 25.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Advair diskus 50/250", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054032756a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 72.00, "discounted_cash": 43.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Advair diskus 50/500", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054032856a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methergine 0.2 mg tab", "drug_information": { "unit": 0.20, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054063905a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 645.00, "discounted_cash": 387.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lithium carbon 300 mg cap", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054252725", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dexamethasone 1mg/ml 30ml", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054317644", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 68.00, "discounted_cash": 40.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fluticasone propinate nas spr", "drug_information": { "unit": 120.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054327099A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 211.00, "discounted_cash": 126.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lorazepam 2mg/ml oral", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054353244A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Versed 10mg/5ml liquid", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054356699", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 61.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mycellex troche ud", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054414622", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 18.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dexamethasone 6 mg tab", "drug_information": { "unit": 6.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054418625", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methotrexate 2.5 mg tab", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054455015a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 23.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Decadron 4 mg tab", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054817525", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lithium carbonate 150mg cap", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054852625", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prednisone 5 mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00054872425", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cyclogyl 0.5% eye drop", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00065039515A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cyclogyl 2% opthalmic sol", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00065039702A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 223.00, "discounted_cash": 133.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Entresto 24mg/26mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00078065920", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 116.00, "discounted_cash": 69.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lantus insulin", "drug_information": { "unit": 1.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00088222033", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pencillin vk 250 mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093117401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Coumadin 2 mg tab", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093171310a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pletal 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093206406a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Augmentin 500mg tab ud", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093227434", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Augmentin 875mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093227534", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 28.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Keflex 250 mg cap", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093314501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Keflex 500 mg cap", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093314701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Penicillin vk 250mg susp 100ml", "drug_information": { "unit": 5000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093412774A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 46.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Keflex 250 mg 100 ml susp", "drug_information": { "unit": 5000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093417773", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 165.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sinemet 25/100 tab ud", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00093970201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sevelamer 2.4g pack", "drug_information": { "unit": 2.40, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00115136630", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fenofibrate 54mg tablet", "drug_information": { "unit": 54.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00115551110", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Florinef .1mg tab", "drug_information": { "unit": 0.10, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00115703301", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Peridex 473 ml bottle", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00116200116A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Milk of mag 30 ml", "drug_information": { "unit": 2400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121043130", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Benadryl elixer 5ml", "drug_information": { "unit": 12.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121048905", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ferrous sulfate 300mg /5ml udc", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121053005", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 23.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Orapred 15mg/5ml solution", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121075908", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bactrim ped susp 30ml", "drug_information": { "unit": 160.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121085416a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mycostatin susp 60 ml", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121086805A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lactulose 20gm/30ml soln btl", "drug_information": { "unit": 20.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121087332a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hycodan syp 5 ml", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121103605a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cephulac syrup 30 ml", "drug_information": { "unit": 20.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121115440a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Guaifenesin 200mg/10ml udc", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121148810a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Reglan 10 ml syrup", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121157610", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 28.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Reglan 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121157610a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 28.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mgoh/aloh 1200mg/simethocone", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121176130", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valproic acid 250mg/5ml", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121467505a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xylocaine viscus 20ml", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00121495015a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Celecoxib 20mg capsule", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00025152534", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 94.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Eplerenone 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00025171001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 142.00, "discounted_cash": 85.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Brompheniramine/phenylephrine", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00031223513A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Creon 24000", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00032263601A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 50.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dymista nasal spray", "drug_information": { "unit": 120.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00037024523", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11024.00, "discounted_cash": 6614.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Premarin vag cream 0.625mg/grm", "drug_information": { "unit": 0.63, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00046087221A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 151.00, "discounted_cash": 90.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Estrogen 0.625mg tablet", "drug_information": { "unit": 0.63, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00046110281", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 42.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lumigan 0.01% eye drop", "drug_information": { "unit": 50.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023320503A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 51744.00, "discounted_cash": 31046.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Refresh optive 15ml opthalmic", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00023324015A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Systane ulta lubricat eye drps", "drug_information": { "unit": 180.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00065143105", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 66.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fesoterdine fumarate 8mg er tb", "drug_information": { "unit": 8.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00069024430", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 55.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zithromax suspension 200mg/5ml", "drug_information": { "unit": 1200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00069314019", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.00, "discounted_cash": 31.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pregabalin 75 mg cap", "drug_information": { "unit": 75.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00071101441B", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 107.00, "discounted_cash": 64.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Synthroid 25 mcg", "drug_information": { "unit": 0.03, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00074434190A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Synthroid 0.05 mg tab", "drug_information": { "unit": 0.05, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00074455211", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Synthroid 75 mcg", "drug_information": { "unit": 0.08, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00074518219", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Synthroid 88 mcg", "drug_information": { "unit": 0.09, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00074659490", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Synthroid 0.1 mg tab", "drug_information": { "unit": 0.10, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00074662411", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Levothyroxine 0.112 mg tablet", "drug_information": { "unit": 0.11, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00074929690A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nitrobid ointment 2% one dose", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00281032608", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hurricane spray", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00283067902", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 390.00, "discounted_cash": 234.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lokelma 5gm packet", "drug_information": { "unit": 5.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00310110539", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 284.00, "discounted_cash": 170.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lokelma 10gm packet", "drug_information": { "unit": 10.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00310111039", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 284.00, "discounted_cash": 170.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Breztri 15mg inhaler", "drug_information": { "unit": 28.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00310461612", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17194.00, "discounted_cash": 10316.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Breztri 15mg inhaler", "drug_information": { "unit": 28.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00310461639", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 471.00, "discounted_cash": 282.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dapagliflozin 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00310620530", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 121.00, "discounted_cash": 72.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chlorthalidone 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378022201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Haldol 1 mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378025701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fenofibrate 145 mg tab", "drug_information": { "unit": 145.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378306677A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acamprosate 333mg tab", "drug_information": { "unit": 333.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378633380a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Estradiol 0.01% vaginal crm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378877035a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 23.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nitro dur patch 2.5", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378910293", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nitro dur patch 5.0", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378910493", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nitro dur patch 10", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378911293", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nitro dur patch 15", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378911693", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Duregesic 25mcg patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378912198", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 82.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Duragesic 50ug/hr patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378912298", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 253.00, "discounted_cash": 151.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Duragesic 75mcg patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378912398", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 231.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Duragesic 100ug/hr patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00378912498", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 512.00, "discounted_cash": 307.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ethyl chloride 4oz spray", "drug_information": { "unit": 120.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00386000103", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 379.00, "discounted_cash": 227.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ethyl chloride 103.5 ml topic", "drug_information": { "unit": 103.50, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00386000111", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 292.00, "discounted_cash": 175.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glycerin usp 480ml", "drug_information": { "unit": 480.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00395103116", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 234.00, "discounted_cash": 140.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocodone acetaminphen 5/325", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00406012362", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tylenol w/cod #3 tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00406048462a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Percocet 5 tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00406051262A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Oxycodone 5mg tablet", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00406055262", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dilaudid 2 mg po", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00406324301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Morphine 5mg/0.25ml oral soln", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00406800315A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ms contin 30 mg tab", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00406833062", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Trelegy ellipta 200/62.5/25mcg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00173089314", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 66.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Theragesic creme", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00178032003", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Symbicort 160/4.5 ihaler", "drug_information": { "unit": 60.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00186037028A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 529.00, "discounted_cash": 317.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Symbicort 80/4.5", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00186037220A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 561.00, "discounted_cash": 336.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Brilinta 90mg tab", "drug_information": { "unit": 90.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00186077760A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 44.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bupropion 150mg xl", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00187073030A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sodium chloride 1gm tablet", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00223176001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xanax 0.25 mg tab", "drug_information": { "unit": 0.25, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00228202710a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xanax 0.5 mg tab", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00228202910a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Propranolol hci 120mg la cap", "drug_information": { "unit": 120.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00228278011a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 17.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pilocarpine 7.5 mg tablet", "drug_information": { "unit": 7.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00228283711", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hibiclens 8 oz topical solutio", "drug_information": { "unit": 240.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00234057508", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 52.00, "discounted_cash": 31.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Questran packet", "drug_information": { "unit": 4.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00245003642", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 29.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Breo ellipta 200/25mcg inh", "drug_information": { "unit": 28.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00173088214A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 32.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Trelegy ellipta powder", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00173088714A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 66.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Breo ellipta 100/25", "drug_information": { "unit": 14.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00173085910A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amoxicillin 400mg/5ml 100ml su", "drug_information": { "unit": 8000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00143988701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 56.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aristocort cr 0.1% 15gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00168000415", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocortisone cr 1% 30 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00168001531", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valisone oint 0.1% 15 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00168003315", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 36.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valisone cream 0.1% 15 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00168004015", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emla cream 5 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00168035755", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dorzolamide hci timolol ophth", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "42571014726a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 117.00, "discounted_cash": 70.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Opium tincture 10mg/ml", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "42799021701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 36.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Polyethylene glycol 3350 255gm", "drug_information": { "unit": 238.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "43386031208A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 29.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cymbalta 30mg capsule", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "43547038003a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nitrostat 0.4 mg tab 25's", "drug_information": { "unit": 0.40, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "43598043635a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glucosa-chond 250/200mg cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "40985023023", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cholecalciferol 5000 un cap", "drug_information": { "unit": 5000.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "40985027288A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "A&d ointment 57g", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "41100081122a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Coenzyme q10 50mg cap", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "35046000431a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Metamucil inst pkg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "37000002404A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Debrox ear drops 1/2 oz", "drug_information": { "unit": 270.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "42037010478a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gabapentin 250mg/5ml solution", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "42192060816", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Propranolol er 80mg", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "42291052301", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vancocin 125mg cap", "drug_information": { "unit": 125.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "42494045020a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 301.00, "discounted_cash": 180.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocortisone 10mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "42543014101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Apresolin 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722052001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Demadex 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722053101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Levetiracetam 100 mg/ml sol", "drug_information": { "unit": 1700.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722057447a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 63.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rapaflo 8mg cap", "drug_information": { "unit": 8.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722063630a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 90.00, "discounted_cash": 54.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valacyclovir 500mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722070430a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Famciclovir 500mg tablet", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722070830A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 122.00, "discounted_cash": 73.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Detrol 2mg tablet", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722080660a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valganciclovir 450 mg tab", "drug_information": { "unit": 450.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722083260", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 618.00, "discounted_cash": 370.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Omega-3-acid ethyl 1 gm cap", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722093612A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ranexa 500mg tablet", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "27241012502a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenergan cod 118 ml", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "27808006502a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.00, "discounted_cash": 6.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rosuvastatin calcium 20mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "27808015701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 86.00, "discounted_cash": 51.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lamotrigine 100mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "29300011201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 27.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dutasteride 0.5mg cap", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "31722013130a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neo/poly/gramicidin opth sol", "drug_information": { "unit": 180.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208079062", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 653.00, "discounted_cash": 391.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ilotycin oph 1/8 oz (erymicin)", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208091055A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Liftigrast 5% eye drops", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208091105A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Erythromycin base 250 mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24338012203a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 82.00, "discounted_cash": 49.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Erythromycin ethyl 400 mg/5ml", "drug_information": { "unit": 8000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24338013013A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6352.00, "discounted_cash": 3811.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Baby aspirin", "drug_information": { "unit": 81.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24385002868a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Petrolatum jelly jar 368g", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24385009227", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lotrim cream 1% 15 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24385020503A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Anti itch crm 2% 28.4g tube", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24385021003", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Colace 5 ml", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24385046843A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tums", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24385047847A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dermoplast spray 3 oz", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "16864068001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 42.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Klonopin 1mg tablet", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "16729013700a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrodiuril 25 mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "16729018301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mycophenolic acid 360gm dr tab", "drug_information": { "unit": 360.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "16729018929", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 52.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Folic acid 1mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "11534016501A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pramipexole 0.25mg tablet", "drug_information": { "unit": 0.25, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "13668009290A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Felodipine er 5 mg", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "13668013301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidocaine hydrocort 3% 5% crm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "13925016001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ferrous gluconate 325mg tablet", "drug_information": { "unit": 324.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "20555001900a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Permethrin 5% cream 60 gm", "drug_information": { "unit": 60.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "21922002107a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 175.00, "discounted_cash": 105.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Calan 80 mg tab", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "23155002601A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glyburide 2.5mg", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "23155005701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Micronase 5 mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "23155005801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Muro 128 5% eye solution 15 ml", "drug_information": { "unit": 270.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208027715", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3138.00, "discounted_cash": 1882.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Besivance 0.6% opth susp", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208044605", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 442.00, "discounted_cash": 265.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Voltaren eye drops", "drug_information": { "unit": 45.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208045705a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 80.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Brinzolamide 1% eye suspension", "drug_information": { "unit": 150.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208046415A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1366.00, "discounted_cash": 819.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dorzolamide 2% btl", "drug_information": { "unit": 180.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208048510a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7930.00, "discounted_cash": 4758.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Preservision areds 2 tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208053210", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Garamycin oph sol 5 ml", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208058060a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tropicamide 1% eye solutn 15ml", "drug_information": { "unit": 90.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208058564a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sulamyd sod oph 10% 15ml", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "24208067004a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 64.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pyridoxine 50 mg tab (vit b6)", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "10006073017a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Transdermal scopalamine ptch", "drug_information": { "unit": 1.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "10019055390", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 204.00, "discounted_cash": 122.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Desflurane 240ml bottle", "drug_information": { "unit": 240.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "10019064634a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1440.00, "discounted_cash": 864.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vantin 100 mg tab ud", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00781543820", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Biaxin 250mg suspension", "drug_information": { "unit": 2500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00781602352A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 248.00, "discounted_cash": 148.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amoxicillin 125mg/5ml 100ml", "drug_information": { "unit": 2500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00781603946", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 20.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amoxicillin 250mg/5ml 100ml", "drug_information": { "unit": 5000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00781604146", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Medihoney gel topical", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "09958003471", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cardizem cd 240 mg tab", "drug_information": { "unit": 240.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "10370083109a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Anusol hc supp", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00713050324", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 206.00, "discounted_cash": 123.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenergan 25 mg supp", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00713052612", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenergan 12.5 mg supp", "drug_information": { "unit": 12.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00713053612", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mometasone 0.1% cream", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00713063415a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amoxicillin 500mg cap", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00781261301A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Proventil inhaler 6.7gm", "drug_information": { "unit": 200.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00781729685a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Trifluoperazine 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00781803601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Calmoseptin oint 113gm tube", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00799000104", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bethanechol 10mg tablet", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00832051101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Magnesium citrate 10 oz", "drug_information": { "unit": 296.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00869016638A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pedinol phenol ez swab 89% top", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00884629730", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 26.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ascorbic acid 500mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904052361", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Theragran m tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904053061", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Milk of magnesia 355ml", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904078816A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 20.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Os cal tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904188361", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vitamin a 10000 un cap", "drug_information": { "unit": 10000.00, "type": "UN" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904208560A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ocean spray (normal saline)", "drug_information": { "unit": 120.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904386575", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sudafed 30 mg tablet", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904505359", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iron polysaccharide 150mg cap", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904539561A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Calcium + vit d 500mg", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904546052a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Famotidine 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904552987A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Motrin 400 mg tab", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904585361", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Motrin 600 mg tab", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904585461A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Motrin 800 mg tab", "drug_information": { "unit": 800.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904585561A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Digoxin .25 mg tab", "drug_information": { "unit": 0.25, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904592261A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Citalopram 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904608461a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Atorvastatin 20mg tablet", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904629161", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Levofloxacin 250mg tablet", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904635161A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Levofloxacin 500mg tablet", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904635261A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Levofloxacin 750mg tab", "drug_information": { "unit": 750.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904635361a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amlodipone 5mg tablet", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904637061a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 10.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dulcolax 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904640761A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lexapro 10mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904642661A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Imdur 30 mg tab", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904644961a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Protonix 40mg tablet", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904647461A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Neurontin 100mg tablet", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904666561a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cetirizine 10mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904671760a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Guaifenesin er 600 mg tab", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904671839a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tylenol 500 mg cap ext stghth", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904673061a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ibuprofen 200mg tablet", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904674780a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acetaminophen 325mg tablet", "drug_information": { "unit": 325.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904677361A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zestril 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904679761a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Singulair 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904680861a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glycolax 17gm glycolax", "drug_information": { "unit": 17.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904693181A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ditropan 5 mg", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904702761a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lasix 40 mg tab", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904717861a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Docusate sodium 100 mg/10ml", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904718361a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lisinopril 40mg tablet", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904720061a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pepto bismol tablet", "drug_information": { "unit": 262.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904720546a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Robafen dm sugar free", "drug_information": { "unit": 118.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904722320a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Coreg 6.25 mg tab", "drug_information": { "unit": 6.25, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904730661a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Corey 12.5mg tablet", "drug_information": { "unit": 12.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904730761a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fluoxetine 10 mg cap", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904734561A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Feosol tab", "drug_information": { "unit": 325.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904759161", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Loperamide 2mg tablet", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904772524", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prosight tablet", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00904773518", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Catapres tt 1 patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00591350804a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 318.00, "discounted_cash": 190.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Catapres tt 2 patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00591350904a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 428.00, "discounted_cash": 256.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Catapres tt 3 patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00591351004a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 445.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tranexamic 650mg tab", "drug_information": { "unit": 650.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00591372030A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Valproic acid 250mg cap", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00591401201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Trihexyphenidyl 5mg tab", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00591533701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Atrovent inhaler", "drug_information": { "unit": 200.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00597008717", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 955.00, "discounted_cash": 573.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Spiriva respimat 2.5mcg actuat", "drug_information": { "unit": 28.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00597010051a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5040.00, "discounted_cash": 3024.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tradjenta 5mg", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00597014030A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 168.00, "discounted_cash": 100.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Empagliflozin 10 mg tab", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00597015230", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 67.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Jardiance 25mg", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00597015390A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 67.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Orajel oral anesthetic", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00573021825A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bromocriptine 2.5 mg tab", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00574010603A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Urispas 100 mg tab", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00574011501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pradaxa 75mg cap", "drug_information": { "unit": 75.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00597035556A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 19.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dabigatran etexilate 150mg", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00597036082A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 19.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Inderal 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00603548321a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Charcoal liquid 50 gm", "drug_information": { "unit": 50.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00574052176b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 227.00, "discounted_cash": 136.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nystop powder topical", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00574200815A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.00, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aspirin 5gm supp", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00574703412", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dulcolax 10 mg supp", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00574705050a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bentyl 20mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00591079501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Docosanol crm 10% 2gm tube", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536142704A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Capsaicin 0.025% crm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536252525", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Habitrol 14 mg patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536589588A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Habitrol 21 mg patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536589688A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Primidone 50mg tab", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00527130101A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Probenecid 500 mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00527136701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chlopheniramine maleate 4mg po", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536100610a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Guaifenesin dm er 600mg/30mg", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536116137", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chloraseptic spray 1.5 oz", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536122858a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phazyme drops 30 ml", "drug_information": { "unit": 66.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536130375a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zinc oxide oint 1 oz", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536131628a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zinc oxide ointment 1 lb", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00536131698a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 51.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Propylthiouracil 50mg tablet", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00480924201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "K phos tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00486111101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Duo-neb", "drug_information": { "unit": 3.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00487020101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sodium chloride inhal 0.9% 3ml", "drug_information": { "unit": 3.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00487930133", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Myrbetriq 25 mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00469260130A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 88.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Estradiol 42.5g cream", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00430375414", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 46.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sodium hypochlorite top sol .5", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00436094616", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Armour thyroid 30mg tablet", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00456045801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bystolic 2.5 mg tab", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "00456140230A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Melatonin 1 mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "74312002832A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zovirax 200 mg cap", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "72578000201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zonisamide 100mg capsule", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "72578004201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acyclovir 5% ointment 15 gm", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "72578008201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 415.00, "discounted_cash": 249.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Zinc sulfate 220mg capsule", "drug_information": { "unit": 220.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "77333098310a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dulera 200 mcg/5 mcg inhaler", "drug_information": { "unit": 60.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "78206012602a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 766.00, "discounted_cash": 459.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vitamin d3 315mg-5mcg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "80681011500", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Augmentin 250mg/75ml susp", "drug_information": { "unit": 3750.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "81964020410a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 635.00, "discounted_cash": 381.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidoderm 5% patch", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "82347050504a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 90.00, "discounted_cash": 54.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Biotin 5mg cap", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "87701040734a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vitamin e 400 inter units", "drug_information": { "unit": 400.00, "type": "F2" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "87701040754A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Osteo biflex triple strength", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "87701040764A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Acidophilus xs tablet", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "87701040808a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Melatonin 5mg", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "87701040814a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Red yeast rice 600mg cap", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "87701040826", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tegretol 100mg/5ml suspension", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70954024010a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Estradiol 0.5 mg tab", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70954056410a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Alogliptin 25mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "71610030009", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Aquaphor ointment 396 gm jar", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "72140063608a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Monurol 3 gm packet", "drug_information": { "unit": 3.00, "type": "GM" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70700026894a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 964.00, "discounted_cash": 578.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mephyton 5 mg", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70710101403A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 643.00, "discounted_cash": 385.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ursodiol 250mg tab", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70710112701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mesalamine 1000mg rectal sup", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70710130207A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 367.00, "discounted_cash": 220.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hyoscyamine sulf 0.125mg tab", "drug_information": { "unit": 0.13, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70156010501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phenergan dm 120 ml susp", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70436015541a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sotalol 80mg tablet", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70515010510A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 244.00, "discounted_cash": 146.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Carbidopa 25 mg tab", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "68682020025A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 50.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lopid 600 mg ud", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69097082103a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nabumetone 500 mg", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69097096507a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nadolol 40 mg tab", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69238112409a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 52.00, "discounted_cash": 31.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Oseltamivir phosphate 45mg cap", "drug_information": { "unit": 45.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69238126501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 136.00, "discounted_cash": 81.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Otopatatine hcl 1% 02 5ml", "drug_information": { "unit": 90.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70069001701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1631.00, "discounted_cash": 978.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Azelastine 0.05% eye drops 6ml", "drug_information": { "unit": 120.00, "type": "EA" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70069009101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 420.00, "discounted_cash": 252.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lasix 20 mg tab", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69315011601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lasix 80 mg tab", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69315011801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lorazepam 0.5mg tablet", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69315090401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.00, "discounted_cash": 3.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ativan 1mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69315090501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 4.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Chlorhexidine gluconate sol", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69339013817a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Felodipine er 2.5 mg tab", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69367026401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Theophylline 400 mg er tab", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69367041401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Benzonatate 100mg cap", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69452014320a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ergocalciferol 50000 un cap", "drug_information": { "unit": 50000.00, "type": "F2" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69452015120a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nimodipine 30mg cap", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69452020920", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 177.00, "discounted_cash": 106.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hytrin 1 mg tab", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69452033020a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Multi-vite liquid 15ml", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69618000858", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Benadryl 25mg cap", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69618002401b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mylicon 80 mg tab", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69618003301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Docusate sodium/senna unit dos", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "69618006501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1.50, "discounted_cash": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methocarbamol 500mg tab", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70010075401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 3.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Robaxin 750 mg tab", "drug_information": { "unit": 750.00, "type": "ME" }, "code_information": [ { "code": "A9270", "type": "HCPCS" }, { "code": "70010077001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 4.11, "10th_percentile": 0.46, "90th_percentile": 27.73, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 17.50, "10th_percentile": 12.79, "90th_percentile": 22.22, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 63.79, "10th_percentile": 29.34, "90th_percentile": 98.24, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m sestamibi", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 463.25, "discounted_cash": 277.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 813.83, "10th_percentile": 797.80, "90th_percentile": 829.85, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 813.83, "10th_percentile": 797.80, "90th_percentile": 829.85, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 273.42, "10th_percentile": 228.68, "90th_percentile": 287.22, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 726.38, "10th_percentile": 726.38, "90th_percentile": 726.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 93.13, "10th_percentile": 90.80, "90th_percentile": 99.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 267.95, "10th_percentile": 214.37, "90th_percentile": 287.22, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 187.57, "10th_percentile": 168.89, "90th_percentile": 267.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.79, "10th_percentile": 682.79, "90th_percentile": 682.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.79, "10th_percentile": 682.79, "90th_percentile": 682.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 252.01, "10th_percentile": 239.90, "90th_percentile": 299.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Technetium tc 99m sestamibi", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 463.25, "discounted_cash": 277.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 813.83, "10th_percentile": 797.80, "90th_percentile": 829.85, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 813.83, "10th_percentile": 797.80, "90th_percentile": 829.85, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 273.42, "10th_percentile": 228.68, "90th_percentile": 287.22, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 726.38, "10th_percentile": 726.38, "90th_percentile": 726.38, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 93.13, "10th_percentile": 90.80, "90th_percentile": 99.88, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 267.95, "10th_percentile": 214.37, "90th_percentile": 287.22, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 187.57, "10th_percentile": 168.89, "90th_percentile": 267.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.79, "10th_percentile": 682.79, "90th_percentile": 682.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 682.79, "10th_percentile": 682.79, "90th_percentile": 682.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 252.01, "10th_percentile": 239.90, "90th_percentile": 299.88, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m tetrofosmin", "code_information": [ { "code": "A9502", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 320.75, "discounted_cash": 192.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Technetium tc99m tetrofosmin", "code_information": [ { "code": "A9502", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 320.75, "discounted_cash": 192.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m medronate", "code_information": [ { "code": "A9503", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 125.25, "discounted_cash": 75.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m medronate per study", "code_information": [ { "code": "A9503", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 125.25, "discounted_cash": 75.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thallium chloride t1201 mci", "code_information": [ { "code": "A9505", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 537.00, "discounted_cash": 322.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tl201 thallium", "code_information": [ { "code": "A9505", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 537.00, "discounted_cash": 322.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc 04 pertechnetate", "code_information": [ { "code": "A9512", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 33.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m pertechnetate", "code_information": [ { "code": "A9512", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 33.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I-123 cap per 100 uci", "code_information": [ { "code": "A9516", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iodine i-123 sod iodide mic", "code_information": [ { "code": "A9516", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m exametazime", "code_information": [ { "code": "A9521", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1556.50, "discounted_cash": 933.90, "minimum": 794.32, "maximum": 2328.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2328.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2328.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 794.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m exametazime per dose", "code_information": [ { "code": "A9521", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1556.50, "discounted_cash": 933.90, "minimum": 794.32, "maximum": 2328.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2328.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2328.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 794.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m mebrofenin", "code_information": [ { "code": "A9537", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 271.25, "discounted_cash": 162.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.09, "10th_percentile": 84.09, "90th_percentile": 84.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 162.17, "10th_percentile": 162.17, "90th_percentile": 162.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.84, "10th_percentile": 26.08, "90th_percentile": 28.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.69, "10th_percentile": 51.92, "90th_percentile": 57.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.56, "10th_percentile": 61.47, "90th_percentile": 73.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 190.32, "10th_percentile": 190.32, "90th_percentile": 190.32, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 190.32, "10th_percentile": 190.32, "90th_percentile": 190.32, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m mebrofenin study dose", "code_information": [ { "code": "A9537", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 271.25, "discounted_cash": 162.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 84.09, "10th_percentile": 84.09, "90th_percentile": 84.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 162.17, "10th_percentile": 162.17, "90th_percentile": 162.17, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.84, "10th_percentile": 26.08, "90th_percentile": 28.40, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.69, "10th_percentile": 51.92, "90th_percentile": 57.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.56, "10th_percentile": 61.47, "90th_percentile": 73.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 190.32, "10th_percentile": 190.32, "90th_percentile": 190.32, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 190.32, "10th_percentile": 190.32, "90th_percentile": 190.32, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m pentetate", "code_information": [ { "code": "A9539", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 248.00, "discounted_cash": 148.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.53, "10th_percentile": 58.53, "90th_percentile": 58.53, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m pentetate study dose", "code_information": [ { "code": "A9539", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 248.00, "discounted_cash": 148.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 58.53, "10th_percentile": 58.53, "90th_percentile": 58.53, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m albumin agg study dose", "code_information": [ { "code": "A9540", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 125.25, "discounted_cash": 75.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.58, "10th_percentile": 29.58, "90th_percentile": 29.58, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m maa", "code_information": [ { "code": "A9540", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 125.25, "discounted_cash": 75.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.58, "10th_percentile": 29.58, "90th_percentile": 29.58, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m sulfur colloid", "code_information": [ { "code": "A9541", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 166.75, "discounted_cash": 100.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m sulfur colloid study dos", "code_information": [ { "code": "A9541", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 166.75, "discounted_cash": 100.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "F-18 fdg dx sudy dose", "code_information": [ { "code": "A9552", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1183.50, "discounted_cash": 710.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 358.13, "10th_percentile": 351.12, "90th_percentile": 365.14, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 537.53, "10th_percentile": 470.89, "90th_percentile": 1035.37, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 482.16, "10th_percentile": 482.16, "90th_percentile": 482.16, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.98, "10th_percentile": 112.66, "90th_percentile": 122.95, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 366.89, "10th_percentile": 366.89, "90th_percentile": 366.89, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 215.73, "10th_percentile": 209.55, "90th_percentile": 239.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "F18 fdg", "code_information": [ { "code": "A9552", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1183.50, "discounted_cash": 710.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 358.13, "10th_percentile": 351.12, "90th_percentile": 365.14, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 537.53, "10th_percentile": 470.89, "90th_percentile": 1035.37, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 482.16, "10th_percentile": 482.16, "90th_percentile": 482.16, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 115.98, "10th_percentile": 112.66, "90th_percentile": 122.95, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 366.89, "10th_percentile": 366.89, "90th_percentile": 366.89, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 215.73, "10th_percentile": 209.55, "90th_percentile": 239.67, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc 99 oxidronate study dose", "code_information": [ { "code": "A9561", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 125.25, "discounted_cash": 75.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.83, "10th_percentile": 38.83, "90th_percentile": 38.83, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.50, "10th_percentile": 11.69, "90th_percentile": 13.50, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.37, "10th_percentile": 22.47, "90th_percentile": 25.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.57, "10th_percentile": 40.75, "90th_percentile": 42.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m oxidronate", "code_information": [ { "code": "A9561", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 125.25, "discounted_cash": 75.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.83, "10th_percentile": 38.83, "90th_percentile": 38.83, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.50, "10th_percentile": 11.69, "90th_percentile": 13.50, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.37, "10th_percentile": 22.47, "90th_percentile": 25.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.57, "10th_percentile": 40.75, "90th_percentile": 42.39, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m mertiatide", "code_information": [ { "code": "A9562", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1187.00, "discounted_cash": 712.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m mertiatide dx study dose", "code_information": [ { "code": "A9562", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1187.00, "discounted_cash": 712.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Piflu f-18 dia 1 millicurie", "code_information": [ { "code": "A9595", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 8523.75, "discounted_cash": 5114.25, "minimum": 329.12, "maximum": 964.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 964.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 964.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 329.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pylarify piflufolasta f18 9mci", "code_information": [ { "code": "A9595", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 8523.75, "discounted_cash": 5114.25, "minimum": 329.12, "maximum": 964.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 964.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 964.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 329.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intravertebral fx aug impl", "code_information": [ { "code": "C1062", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 7666.50, "discounted_cash": 4599.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spinejack expansion kit 4.2 mm", "code_information": [ { "code": "C1062", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 7666.50, "discounted_cash": 4599.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anchor/screw bn/bntis/bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 30370.50, "discounted_cash": 18222.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3657.10, "10th_percentile": 1313.57, "90th_percentile": 7813.34, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2376.52, "10th_percentile": 933.83, "90th_percentile": 8573.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 187.23, "10th_percentile": 14.81, "90th_percentile": 356.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 379.75, "10th_percentile": 379.75, "90th_percentile": 379.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 290.21, "10th_percentile": 80.13, "90th_percentile": 5336.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9034.21, "10th_percentile": 9034.21, "90th_percentile": 9034.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9034.21, "10th_percentile": 9034.21, "90th_percentile": 9034.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.08, "10th_percentile": 72.08, "90th_percentile": 72.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Minuteman mis fusion plate", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 30370.50, "discounted_cash": 18222.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3657.10, "10th_percentile": 1313.57, "90th_percentile": 7813.34, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2376.52, "10th_percentile": 933.83, "90th_percentile": 8573.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 187.23, "10th_percentile": 14.81, "90th_percentile": 356.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 379.75, "10th_percentile": 379.75, "90th_percentile": 379.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 290.21, "10th_percentile": 80.13, "90th_percentile": 5336.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9034.21, "10th_percentile": 9034.21, "90th_percentile": 9034.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 9034.21, "10th_percentile": 9034.21, "90th_percentile": 9034.21, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.08, "10th_percentile": 72.08, "90th_percentile": 72.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cath bal dil non-vascular", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 580.00, "discounted_cash": 348.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ezdialtor ballon 11 12 13", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 580.00, "discounted_cash": 348.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cath inf per/cent/midline", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3144.25, "discounted_cash": 1886.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 983.50, "10th_percentile": 983.50, "90th_percentile": 983.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 281.31, "10th_percentile": 281.31, "90th_percentile": 281.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Picc line kit 40 cm 5.5 fr", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3144.25, "discounted_cash": 1886.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 983.50, "10th_percentile": 983.50, "90th_percentile": 983.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 281.31, "10th_percentile": 281.31, "90th_percentile": 281.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cath thrombectomy/embolect", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 485.75, "discounted_cash": 291.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Catheter embolectomy 4f appli", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 485.75, "discounted_cash": 291.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bs novi ipg", "code_information": [ { "code": "C1767", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 58712.75, "discounted_cash": 35227.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17491.44, "10th_percentile": 17491.44, "90th_percentile": 17491.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Generator neuro non-recharg", "code_information": [ { "code": "C1767", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 58712.75, "discounted_cash": 35227.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17491.44, "10th_percentile": 17491.44, "90th_percentile": 17491.44, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Guide wire", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3552.50, "discounted_cash": 2131.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 348.14, "10th_percentile": 348.14, "90th_percentile": 348.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kdb glide", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3552.50, "discounted_cash": 2131.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 348.14, "10th_percentile": 348.14, "90th_percentile": 348.14, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Joint device (implantable)", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 58509.75, "discounted_cash": 35105.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8108.29, "10th_percentile": 4915.47, "90th_percentile": 15561.83, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1698.99, "10th_percentile": 764.94, "90th_percentile": 2300.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4367.89, "10th_percentile": 1631.69, "90th_percentile": 5537.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5338.48, "10th_percentile": 5058.89, "90th_percentile": 5618.06, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Persona ps cm", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 58509.75, "discounted_cash": 35105.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8108.29, "10th_percentile": 4915.47, "90th_percentile": 15561.83, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1698.99, "10th_percentile": 764.94, "90th_percentile": 2300.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4367.89, "10th_percentile": 1631.69, "90th_percentile": 5537.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5338.48, "10th_percentile": 5058.89, "90th_percentile": 5618.06, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bs coveredge 32 lead kit 50 cm", "code_information": [ { "code": "C1778", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 16079.75, "discounted_cash": 9647.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lead neurostimulator", "code_information": [ { "code": "C1778", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 16079.75, "discounted_cash": 9647.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intraocular lens impl new tech", "code_information": [ { "code": "C1780", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2964.25, "discounted_cash": 1778.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lens intraocular (new tech)", "code_information": [ { "code": "C1780", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2964.25, "discounted_cash": 1778.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mesh (implantable)", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 31264.25, "discounted_cash": 18758.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2709.87, "10th_percentile": 2709.87, "90th_percentile": 2709.87, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6062.51, "10th_percentile": 4639.17, "90th_percentile": 7485.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 942.34, "10th_percentile": 942.34, "90th_percentile": 942.34, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1354.93, "10th_percentile": 1354.93, "90th_percentile": 1354.93, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sorbafix mesh 5.4 x 7.0 lg", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 31264.25, "discounted_cash": 18758.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2709.87, "10th_percentile": 2709.87, "90th_percentile": 2709.87, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6062.51, "10th_percentile": 4639.17, "90th_percentile": 7485.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 942.34, "10th_percentile": 942.34, "90th_percentile": 942.34, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1354.93, "10th_percentile": 1354.93, "90th_percentile": 1354.93, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ocular imp aqueous drain", "code_information": [ { "code": "C1783", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11294.50, "discounted_cash": 6776.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ocular imp aqueous drain de", "code_information": [ { "code": "C1783", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11294.50, "discounted_cash": 6776.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Patient progr neurostim", "code_information": [ { "code": "C1787", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 111952.48, "discounted_cash": 67171.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1118.87, "10th_percentile": 1118.87, "90th_percentile": 1118.87, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5034.16, "10th_percentile": 4926.44, "90th_percentile": 5141.87, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6898.17, "10th_percentile": 6898.17, "90th_percentile": 6898.17, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 981.72, "10th_percentile": 981.72, "90th_percentile": 981.72, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Port catheter implanted all", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2257.50, "discounted_cash": 1354.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1519.24, "10th_percentile": 1354.19, "90th_percentile": 1519.24, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 163.13, "10th_percentile": 159.94, "90th_percentile": 166.32, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 421.67, "10th_percentile": 421.67, "90th_percentile": 421.67, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Port indwelling imp", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2257.50, "discounted_cash": 1354.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1519.24, "10th_percentile": 1354.19, "90th_percentile": 1519.24, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 163.13, "10th_percentile": 159.94, "90th_percentile": 166.32, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 421.67, "10th_percentile": 421.67, "90th_percentile": 421.67, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Generator neuro rechg bat sy", "code_information": [ { "code": "C1820", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 78411.00, "discounted_cash": 47046.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16405.20, "10th_percentile": 16405.20, "90th_percentile": 16405.20, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 934.19, "10th_percentile": 934.19, "90th_percentile": 934.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14954.32, "10th_percentile": 14954.32, "90th_percentile": 14954.32, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nevro generator system", "code_information": [ { "code": "C1820", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 78411.00, "discounted_cash": 47046.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16405.20, "10th_percentile": 16405.20, "90th_percentile": 16405.20, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 934.19, "10th_percentile": 934.19, "90th_percentile": 934.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14954.32, "10th_percentile": 14954.32, "90th_percentile": 14954.32, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Interspinous implant", "code_information": [ { "code": "C1821", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 33131.50, "discounted_cash": 19878.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Interspinous process device", "code_information": [ { "code": "C1821", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 33131.50, "discounted_cash": 19878.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adapt/ext pacing/neuro lead", "code_information": [ { "code": "C1883", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4556.00, "discounted_cash": 2733.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bs precision s8 adapter 15cm", "code_information": [ { "code": "C1883", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4556.00, "discounted_cash": 2733.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Implant/insert device noc", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11044.00, "discounted_cash": 6626.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mild device disposable kit", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11044.00, "discounted_cash": 6626.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lead neurostim test kit", "code_information": [ { "code": "C1897", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1840.75, "discounted_cash": 1104.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nevro trial lead kit", "code_information": [ { "code": "C1897", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1840.75, "discounted_cash": 1104.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cath suprapubic/cystoscopic", "code_information": [ { "code": "C2627", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 744.25, "discounted_cash": 446.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Suprapubic catheter", "code_information": [ { "code": "C2627", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 744.25, "discounted_cash": 446.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra abdomen w/ or w/o cm", "code_information": [ { "code": "C8902", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra w/o fol w/cont abd", "code_information": [ { "code": "C8902", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6095.75, "discounted_cash": 3657.45, "minimum": 760.38, "maximum": 2229.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2229.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 760.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Praxbind 2.5 gm/50ml vial", "drug_information": { "unit": 2.50, "type": "GM" }, "code_information": [ { "code": "C9399", "type": "HCPCS" }, { "code": "00597019705A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5224.00, "discounted_cash": 3134.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 100mg/100ml premix", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "C9399", "type": "HCPCS" }, { "code": "44567066201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 443.00, "discounted_cash": 265.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Admin influenza virus vac", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.76, "10th_percentile": 6.76, "90th_percentile": 6.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 6.76, "10th_percentile": 6.76, "90th_percentile": 6.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.76, "10th_percentile": 6.76, "90th_percentile": 6.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.81, "10th_percentile": 21.81, "90th_percentile": 21.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine adm influenza", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.76, "10th_percentile": 6.76, "90th_percentile": 6.76, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 6.76, "10th_percentile": 6.76, "90th_percentile": 6.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "1 through 10", "median_amount": 6.83, "10th_percentile": 6.83, "90th_percentile": 6.83, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.76, "10th_percentile": 6.76, "90th_percentile": 6.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.81, "10th_percentile": 21.81, "90th_percentile": 21.81, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Admin pneumococcal vaccine", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.46, "10th_percentile": 6.40, "90th_percentile": 6.53, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vaccine adm pneumonia", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 22.25, "discounted_cash": 13.35, "minimum": 41.04, "maximum": 120.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 120.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.46, "10th_percentile": 6.40, "90th_percentile": 6.53, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 41.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Psa screening", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 330.25, "discounted_cash": 198.15, "minimum": 19.12, "maximum": 56.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 97.50, "10th_percentile": 85.80, "90th_percentile": 102.38, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 56.05, "count": "64", "median_amount": 272.08, "10th_percentile": 206.45, "90th_percentile": 279.14, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 56.05, "count": "1 through 10", "median_amount": 277.85, "10th_percentile": 277.85, "90th_percentile": 277.85, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.94, "10th_percentile": 96.03, "90th_percentile": 99.86, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 80.56, "10th_percentile": 76.78, "90th_percentile": 97.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "80", "median_amount": 97.10, "10th_percentile": 95.55, "90th_percentile": 100.33, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19.12, "count": "1 through 10", "median_amount": 96.52, "10th_percentile": 96.52, "90th_percentile": 101.35, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 102.38, "10th_percentile": 95.55, "90th_percentile": 102.38, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 95.55, "10th_percentile": 69.24, "90th_percentile": 100.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 100.34, "10th_percentile": 100.34, "90th_percentile": 100.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 100.34, "10th_percentile": 100.34, "90th_percentile": 100.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Colorectal scrn; hi risk ind", "code_information": [ { "code": "G0105", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 5747.63, "discounted_cash": 3448.58, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "1 through 10", "median_amount": 2536.75, "10th_percentile": 2536.75, "90th_percentile": 2536.75, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colon ca scrn not hi rsk ind", "code_information": [ { "code": "G0121", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 5596.05, "discounted_cash": 3357.63, "minimum": 810.97, "maximum": 2377.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2377.71, "count": "1 through 10", "median_amount": 2567.93, "10th_percentile": 2497.31, "90th_percentile": 2638.56, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2377.71, "count": "1 through 10", "median_amount": 2663.58, "10th_percentile": 2663.58, "90th_percentile": 2663.58, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 810.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pap screen thin prep", "code_information": [ { "code": "G0123", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 413.50, "discounted_cash": 248.10, "minimum": 20.06, "maximum": 58.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 58.81, "count": "1 through 10", "median_amount": 340.65, "10th_percentile": 335.04, "90th_percentile": 349.28, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 58.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.63, "10th_percentile": 125.63, "90th_percentile": 125.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.63, "10th_percentile": 125.63, "90th_percentile": 125.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 20.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.62, "10th_percentile": 119.62, "90th_percentile": 119.62, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Screen cerv/vag thin layer", "code_information": [ { "code": "G0123", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 413.50, "discounted_cash": 248.10, "minimum": 20.06, "maximum": 58.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 58.81, "count": "1 through 10", "median_amount": 340.65, "10th_percentile": 335.04, "90th_percentile": 349.28, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 58.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.63, "10th_percentile": 125.63, "90th_percentile": 125.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 125.63, "10th_percentile": 125.63, "90th_percentile": 125.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 20.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 119.62, "10th_percentile": 119.62, "90th_percentile": 119.62, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim nail(s)", "code_information": [ { "code": "G0127", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trim nondysrophic nails any #", "code_information": [ { "code": "G0127", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 164.75, "discounted_cash": 98.85, "minimum": 52.84, "maximum": 154.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 154.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 52.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resp ms therapy ea 15 min", "code_information": [ { "code": "G0237", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 73.25, "discounted_cash": 43.95, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapeutic procd strg endur", "code_information": [ { "code": "G0237", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 73.25, "discounted_cash": 43.95, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oth resp proc indiv", "code_information": [ { "code": "G0238", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 73.25, "discounted_cash": 43.95, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respiratory fcn therapy ea 15", "code_information": [ { "code": "G0238", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 73.25, "discounted_cash": 43.95, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oth resp proc group", "code_information": [ { "code": "G0239", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.61, "10th_percentile": 29.61, "90th_percentile": 29.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "1 through 10", "median_amount": 82.63, "10th_percentile": 82.63, "90th_percentile": 82.63, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.54, "10th_percentile": 20.25, "90th_percentile": 39.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.34, "10th_percentile": 9.85, "90th_percentile": 10.84, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.17, "10th_percentile": 34.17, "90th_percentile": 34.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Resp fcn strengh 2/> indiv", "code_information": [ { "code": "G0239", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 100.50, "discounted_cash": 60.30, "minimum": 34.91, "maximum": 102.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.61, "10th_percentile": 29.61, "90th_percentile": 29.61, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 102.36, "count": "1 through 10", "median_amount": 82.63, "10th_percentile": 82.63, "90th_percentile": 82.63, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 102.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.54, "10th_percentile": 20.25, "90th_percentile": 39.50, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.34, "10th_percentile": 9.85, "90th_percentile": 10.84, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 34.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.17, "10th_percentile": 34.17, "90th_percentile": 34.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj for sacroiliac jt anesth", "code_information": [ { "code": "G0260", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4080.13, "discounted_cash": 2448.08, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 355.39, "10th_percentile": 348.45, "90th_percentile": 362.33, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj for sacroiliac jt anesth", "code_information": [ { "code": "G0260", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3971.54, "discounted_cash": 2382.92, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2431.62, "10th_percentile": 2431.62, "90th_percentile": 2431.62, "methodology": "percent of total billed charges", "modifiers": "50" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2431.62, "10th_percentile": 2431.62, "90th_percentile": 2431.62, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 797.63, "10th_percentile": 797.63, "90th_percentile": 797.63, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "1 through 10", "median_amount": 2570.76, "10th_percentile": 2570.76, "90th_percentile": 2570.76, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 771.34, "10th_percentile": 682.86, "90th_percentile": 943.59, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "1 through 10", "median_amount": 987.07, "10th_percentile": 987.07, "90th_percentile": 987.07, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 769.51, "10th_percentile": 646.39, "90th_percentile": 964.46, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2370.25, "10th_percentile": 2370.25, "90th_percentile": 2370.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 2370.25, "10th_percentile": 2370.25, "90th_percentile": 2370.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 395.54, "10th_percentile": 395.54, "90th_percentile": 395.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj for sacroiliac jt anesth", "code_information": [ { "code": "G0260", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4059.51, "discounted_cash": 2435.71, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "1 through 10", "median_amount": 2047.41, "10th_percentile": 1559.93, "90th_percentile": 2223.06, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 925.68, "10th_percentile": 828.44, "90th_percentile": 1022.92, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 330.98, "10th_percentile": 330.98, "90th_percentile": 330.98, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 889.36, "10th_percentile": 803.22, "90th_percentile": 975.50, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 615.61, "10th_percentile": 615.61, "90th_percentile": 615.61, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj for sacroiliac jt anesth", "code_information": [ { "code": "G0260", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3968.24, "discounted_cash": 2380.94, "minimum": 616.00, "maximum": 1806.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1806.07, "count": "1 through 10", "median_amount": 2327.35, "10th_percentile": 2278.19, "90th_percentile": 2376.51, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1806.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 964.53, "10th_percentile": 834.13, "90th_percentile": 1045.71, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 330.98, "10th_percentile": 330.98, "90th_percentile": 330.98, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 616.00, "count": "1 through 10", "median_amount": 687.07, "10th_percentile": 687.07, "90th_percentile": 687.07, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 923.41, "10th_percentile": 923.41, "90th_percentile": 923.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 763.98, "10th_percentile": 763.98, "90th_percentile": 763.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mnt ind 2nd refer ea 15 min", "code_information": [ { "code": "G0270", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "minimum": 24.77, "maximum": 72.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 24.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mnt subs tx for change dx", "code_information": [ { "code": "G0270", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "minimum": 24.77, "maximum": 72.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 72.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 24.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Group mnt 2 or more 30 mins", "code_information": [ { "code": "G0271", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 40.50, "discounted_cash": 24.30, "minimum": 13.95, "maximum": 40.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mnt grp 2nd refer ea 30 min", "code_information": [ { "code": "G0271", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 40.50, "discounted_cash": 24.30, "minimum": 13.95, "maximum": 40.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 40.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hbot full body chamber 30m", "code_information": [ { "code": "G0277", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 352.75, "discounted_cash": 211.65, "minimum": 122.66, "maximum": 359.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 359.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 359.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 122.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hyperbaric oxy therapy per 30", "code_information": [ { "code": "G0277", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 352.75, "discounted_cash": 211.65, "minimum": 122.66, "maximum": 359.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 359.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 359.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 122.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tomosynthesis mammo", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "minimum": 39.54, "maximum": 115.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 115.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 115.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 39.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx tomosynthesis mammo left", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 44.87, "10th_percentile": 44.87, "90th_percentile": 44.87, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.39, "10th_percentile": 26.39, "90th_percentile": 26.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tomosynthesis mammo right", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tomosynthesis mammo right", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 144.75, "discounted_cash": 86.85, "minimum": 12.97, "maximum": 38.02, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.78, "10th_percentile": 42.70, "90th_percentile": 44.87, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 38.02, "count": "1 through 10", "median_amount": 105.53, "10th_percentile": 99.24, "90th_percentile": 113.40, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 38.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.52, "10th_percentile": 14.19, "90th_percentile": 15.38, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 26.39, "10th_percentile": 25.75, "90th_percentile": 29.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Elec stim other than wound", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 47.75, "discounted_cash": 28.65, "minimum": 11.43, "maximum": 33.53, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 33.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 33.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.60, "10th_percentile": 11.60, "90th_percentile": 11.60, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5.14, "10th_percentile": 4.68, "90th_percentile": 5.14, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 11.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.75, "10th_percentile": 13.75, "90th_percentile": 13.75, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot e-stim unattended", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 47.75, "discounted_cash": 28.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GO", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.63, "10th_percentile": 9.63, "90th_percentile": 9.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrical stimulation unatten", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 47.75, "discounted_cash": 28.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "GP", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.84, "10th_percentile": 11.84, "90th_percentile": 11.84, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.60, "10th_percentile": 11.60, "90th_percentile": 13.92, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.68, "10th_percentile": 4.68, "90th_percentile": 4.68, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.16, "10th_percentile": 10.16, "90th_percentile": 10.16, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colopak per 1-3 screen", "code_information": [ { "code": "G0328", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 79.25, "discounted_cash": 47.55, "minimum": 17.87, "maximum": 52.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 52.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 52.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.08, "10th_percentile": 23.23, "90th_percentile": 52.18, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 17.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.87, "10th_percentile": 22.87, "90th_percentile": 22.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fecal blood scrn immunoassay", "code_information": [ { "code": "G0328", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 79.25, "discounted_cash": 47.55, "minimum": 17.87, "maximum": 52.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 52.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 52.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.08, "10th_percentile": 23.23, "90th_percentile": 52.18, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 17.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.87, "10th_percentile": 22.87, "90th_percentile": 22.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital observation per hr", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 66.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 1278.19, "10th_percentile": 481.25, "90th_percentile": 1636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1711.64, "10th_percentile": 964.38, "90th_percentile": 2313.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "66", "median_amount": 468.93, "10th_percentile": 182.00, "90th_percentile": 542.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 858.25, "10th_percentile": 463.06, "90th_percentile": 1552.45, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 1239.59, "10th_percentile": 477.88, "90th_percentile": 1604.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4438.80, "10th_percentile": 4438.80, "90th_percentile": 4438.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4438.80, "10th_percentile": 4438.80, "90th_percentile": 4438.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 656.37, "10th_percentile": 457.78, "90th_percentile": 1608.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Observation per hour", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 66.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 1278.19, "10th_percentile": 481.25, "90th_percentile": 1636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1711.64, "10th_percentile": 964.38, "90th_percentile": 2313.30, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "66", "median_amount": 468.93, "10th_percentile": 182.00, "90th_percentile": 542.02, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 858.25, "10th_percentile": 463.06, "90th_percentile": 1552.45, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 1239.59, "10th_percentile": 477.88, "90th_percentile": 1604.07, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4438.80, "10th_percentile": 4438.80, "90th_percentile": 4438.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4438.80, "10th_percentile": 4438.80, "90th_percentile": 4438.80, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 656.37, "10th_percentile": 457.78, "90th_percentile": 1608.95, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Direct refer hospital observ", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2006.75, "discounted_cash": 1204.05, "minimum": 545.36, "maximum": 1598.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1598.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1598.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 467.34, "10th_percentile": 467.34, "90th_percentile": 467.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.67, "10th_percentile": 196.67, "90th_percentile": 196.67, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 545.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Direct referral hospital obs", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2006.75, "discounted_cash": 1204.05, "minimum": 545.36, "maximum": 1598.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1598.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1598.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 467.34, "10th_percentile": 467.34, "90th_percentile": 467.34, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.67, "10th_percentile": 196.67, "90th_percentile": 196.67, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 545.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trauma call with critical care", "code_information": [ { "code": "G0390", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3661.00, "discounted_cash": 2196.60, "minimum": 1176.97, "maximum": 3450.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3450.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3450.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1176.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trauma respons w/hosp criti", "code_information": [ { "code": "G0390", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3661.00, "discounted_cash": 2196.60, "minimum": 1176.97, "maximum": 3450.79, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3450.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3450.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1176.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Home sleep test/type 3 porta", "code_information": [ { "code": "G0399", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Home sleep test type iii inter", "code_information": [ { "code": "G0399", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 432.00, "discounted_cash": 259.20, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "26", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Home sleep test type iii", "code_information": [ { "code": "G0399", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 495.50, "discounted_cash": 297.30, "minimum": 139.17, "maximum": 408.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "TC", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 408.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 139.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ekg tracing for initial prev", "code_information": [ { "code": "G0404", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 255.00, "discounted_cash": 153.00, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.79, "10th_percentile": 23.79, "90th_percentile": 23.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ekg tracing for ippe", "code_information": [ { "code": "G0404", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 255.00, "discounted_cash": 153.00, "minimum": 21.78, "maximum": 63.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 63.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.79, "10th_percentile": 23.79, "90th_percentile": 23.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 21.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ekg interp & report wtm", "code_information": [ { "code": "G0405", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 37.75, "discounted_cash": 22.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ekg interpret & report preve", "code_information": [ { "code": "G0405", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 37.75, "discounted_cash": 22.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital op clinic visit", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 401.75, "discounted_cash": 241.05, "minimum": 114.63, "maximum": 336.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital outpt clinic visit", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 401.75, "discounted_cash": 241.05, "minimum": 114.63, "maximum": 336.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 336.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 336.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 114.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test def 1-7 classes", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 419.00, "discounted_cash": 251.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.97, "10th_percentile": 60.80, "90th_percentile": 232.38, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 185.29, "10th_percentile": 83.55, "90th_percentile": 287.03, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.98, "10th_percentile": 162.12, "90th_percentile": 349.84, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.98, "10th_percentile": 72.88, "90th_percentile": 196.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 79.31, "10th_percentile": 58.10, "90th_percentile": 220.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.06, "10th_percentile": 61.06, "90th_percentile": 62.06, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 78.00, "10th_percentile": 58.11, "90th_percentile": 230.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocodone level", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 419.00, "discounted_cash": 251.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 72.97, "10th_percentile": 60.80, "90th_percentile": 232.38, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 185.29, "10th_percentile": 83.55, "90th_percentile": 287.03, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.98, "10th_percentile": 162.12, "90th_percentile": 349.84, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.98, "10th_percentile": 72.88, "90th_percentile": 196.98, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 79.31, "10th_percentile": 58.10, "90th_percentile": 220.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 61.06, "10th_percentile": 61.06, "90th_percentile": 62.06, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 78.00, "10th_percentile": 58.11, "90th_percentile": 230.51, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test def 8-14 classes", "code_information": [ { "code": "G0481", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 368.00, "discounted_cash": 220.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test definitive 8-14 clas", "code_information": [ { "code": "G0481", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 368.00, "discounted_cash": 220.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test def 15-21 classes", "code_information": [ { "code": "G0482", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 466.50, "discounted_cash": 279.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test definitive 15-21 cla", "code_information": [ { "code": "G0482", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 466.50, "discounted_cash": 279.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test def 22+ classes", "code_information": [ { "code": "G0483", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test definitive 22+ class", "code_information": [ { "code": "G0483", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 579.75, "discounted_cash": 347.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo ext iv infusion w pump", "code_information": [ { "code": "G0498", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo extend iv infus w/pump", "code_information": [ { "code": "G0498", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1225.50, "discounted_cash": 735.30, "minimum": 295.04, "maximum": 865.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 865.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 295.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diopter 16.5d", "code_information": [ { "code": "G9519", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 433.25, "discounted_cash": 259.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Final ref +/- 1.0 w/in 90d", "code_information": [ { "code": "G9519", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 433.25, "discounted_cash": 259.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abatacept/maltose 250 mg vial", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J0129", "type": "HCPCS" }, { "code": "00003218713a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3867.00, "discounted_cash": 2320.20, "minimum": 42.95, "maximum": 125.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 125.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 125.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 42.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ofirmev 1000mg/100ml vial", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0131", "type": "HCPCS" }, { "code": "00264410090a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 46.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.39, "10th_percentile": 8.01, "90th_percentile": 12.58, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.71, "10th_percentile": 9.90, "90th_percentile": 21.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetylcysteine inj 6000 mg", "drug_information": { "unit": 6000.00, "type": "ME" }, "code_information": [ { "code": "J0132", "type": "HCPCS" }, { "code": "63323096330", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1451.00, "discounted_cash": 870.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acyclovir 1000mg", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0133", "type": "HCPCS" }, { "code": "55150015520A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 172.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adenocard 6mg/2ml", "drug_information": { "unit": 6.00, "type": "ME" }, "code_information": [ { "code": "J0153", "type": "HCPCS" }, { "code": "67457085502a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 34.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.75, "10th_percentile": 17.75, "90th_percentile": 17.75, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 34.79, "10th_percentile": 22.62, "90th_percentile": 34.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epinepherine 1:10000 10 ml syr", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J0169", "type": "HCPCS" }, { "code": "76329331801A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.23, "10th_percentile": 14.23, "90th_percentile": 14.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.04, "10th_percentile": 42.30, "90th_percentile": 51.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epinepherine 1:1000 1ml amp", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J0169", "type": "HCPCS" }, { "code": "54288010301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 168.00, "discounted_cash": 100.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.23, "10th_percentile": 14.23, "90th_percentile": 14.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.04, "10th_percentile": 42.30, "90th_percentile": 51.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epinephrine 10mg/10ml vial", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J0169", "type": "HCPCS" }, { "code": "54288012001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 288.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.23, "10th_percentile": 14.23, "90th_percentile": 14.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.04, "10th_percentile": 42.30, "90th_percentile": 51.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epinephrine auto-injector 0.3", "drug_information": { "unit": 0.30, "type": "ME" }, "code_information": [ { "code": "J0169", "type": "HCPCS" }, { "code": "49502010202A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1440.00, "discounted_cash": 864.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.23, "10th_percentile": 14.23, "90th_percentile": 14.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.04, "10th_percentile": 42.30, "90th_percentile": 51.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epinephrine 1 mg / ml vial", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J0169", "type": "HCPCS" }, { "code": "42023015925", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 79.00, "discounted_cash": 47.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.23, "10th_percentile": 14.23, "90th_percentile": 14.62, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 51.04, "10th_percentile": 42.30, "90th_percentile": 51.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prolastin c 1000mg", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J0256", "type": "HCPCS" }, { "code": "13533070511", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1410.00, "discounted_cash": 846.00, "minimum": 5.11, "maximum": 14.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 14.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 14.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 473.58, "10th_percentile": 467.09, "90th_percentile": 486.11, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aminophylline 250 mg vial iv", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J0280", "type": "HCPCS" }, { "code": "00409592101A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aminophylline 500mg iv 20ml", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J0280", "type": "HCPCS" }, { "code": "00409592201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 136.00, "discounted_cash": 81.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nexterone premix sol 200 ml ba", "drug_information": { "unit": 360.00, "type": "ME" }, "code_information": [ { "code": "J0282", "type": "HCPCS" }, { "code": "43066036020A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 443.00, "discounted_cash": 265.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.40, "10th_percentile": 2.29, "90th_percentile": 56.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.84, "10th_percentile": 19.86, "90th_percentile": 121.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cordarone 150 mg / 3 ml inj", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "J0282", "type": "HCPCS" }, { "code": "67457015303A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.40, "10th_percentile": 2.29, "90th_percentile": 56.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.84, "10th_percentile": 19.86, "90th_percentile": 121.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amiodarone 900mg/18ml vial", "drug_information": { "unit": 900.00, "type": "ME" }, "code_information": [ { "code": "J0282", "type": "HCPCS" }, { "code": "67457015318", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 45.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 43.40, "10th_percentile": 2.29, "90th_percentile": 56.42, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 70.84, "10th_percentile": 19.86, "90th_percentile": 121.82, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillin 2gm inj", "drug_information": { "unit": 2.00, "type": "GM" }, "code_information": [ { "code": "J0290", "type": "HCPCS" }, { "code": "55150011420A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 153.00, "discounted_cash": 91.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillin 500mg inj", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J0290", "type": "HCPCS" }, { "code": "25021013510A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 17.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillin 1gm inj", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J0290", "type": "HCPCS" }, { "code": "25021013610A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 22.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillin 250mg inj", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J0290", "type": "HCPCS" }, { "code": "00781340278a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 22.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillin/sulbactam 1.5gm", "drug_information": { "unit": 1.50, "type": "GM" }, "code_information": [ { "code": "J0295", "type": "HCPCS" }, { "code": "55150011620A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 44.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anectine 20mg1ml 10ml", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J0330", "type": "HCPCS" }, { "code": "00409662902", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 152.00, "discounted_cash": 91.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.46, "10th_percentile": 7.46, "90th_percentile": 7.47, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.71, "10th_percentile": 7.45, "90th_percentile": 33.97, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apresolin 20mg/ml inj", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J0360", "type": "HCPCS" }, { "code": "63323061401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 98.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 41.63, "10th_percentile": 40.62, "90th_percentile": 50.77, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.05, "10th_percentile": 15.56, "90th_percentile": 16.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 50.77, "10th_percentile": 50.77, "90th_percentile": 50.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 49.76, "10th_percentile": 41.78, "90th_percentile": 59.71, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 44.54, "10th_percentile": 44.54, "90th_percentile": 44.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 44.54, "10th_percentile": 44.54, "90th_percentile": 44.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 40.97, "10th_percentile": 38.12, "90th_percentile": 43.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Azithromycin 500 mg iv", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J0456", "type": "HCPCS" }, { "code": "00069315083A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.50, "10th_percentile": 14.50, "90th_percentile": 14.50, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.76, "10th_percentile": 17.76, "90th_percentile": 17.76, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aztreonam 2 gm vial", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J0457", "type": "HCPCS" }, { "code": "63323040201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 704.00, "discounted_cash": 422.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 641.43, "10th_percentile": 342.10, "90th_percentile": 641.43, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine sulfate 0.4mg ml vial", "drug_information": { "unit": 8.00, "type": "ME" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "63323058003a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 337.00, "discounted_cash": 202.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 1mg/10ml syr", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "00409163010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 0.4mg/1ml inj", "drug_information": { "unit": 0.40, "type": "ME" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "00517100401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 82.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bentyl 10mg/ml 2ml inj", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J0500", "type": "HCPCS" }, { "code": "00517198001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 807.00, "discounted_cash": 484.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fasenra 30mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J0517", "type": "HCPCS" }, { "code": "00310173030", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21079.00, "discounted_cash": 12647.40, "minimum": 161.67, "maximum": 473.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5227.53, "10th_percentile": 4350.23, "90th_percentile": 6295.90, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 473.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 473.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2005.55, "10th_percentile": 2005.55, "90th_percentile": 2005.55, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 161.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3842.24, "10th_percentile": 3730.32, "90th_percentile": 6217.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7883.45, "10th_percentile": 7310.11, "90th_percentile": 8456.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Penicillin g benz 1.2 units", "drug_information": { "unit": 1200000.00, "type": "UN" }, "code_information": [ { "code": "J0558", "type": "HCPCS" }, { "code": "60793060010a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2334.00, "discounted_cash": 1400.40, "minimum": 17.20, "maximum": 50.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 50.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 50.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 17.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Penicillin g benz 1.2 units", "drug_information": { "unit": 1200000.00, "type": "UN" }, "code_information": [ { "code": "J0561", "type": "HCPCS" }, { "code": "60793070110", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3897.00, "discounted_cash": 2338.20, "minimum": 26.71, "maximum": 78.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 78.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 78.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zinplava 1000mg/40ml", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0565", "type": "HCPCS" }, { "code": "00006302500", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15200.00, "discounted_cash": 9120.00, "minimum": 39.47, "maximum": 115.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 115.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 115.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 39.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Buprenorphine/naloxone 8mg/2mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0574", "type": "HCPCS" }, { "code": "43598058201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 50.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Botox 100 unit", "drug_information": { "unit": 100.00, "type": "UN" }, "code_information": [ { "code": "J0585", "type": "HCPCS" }, { "code": "00023114501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6250.00, "discounted_cash": 3750.00, "minimum": 6.42, "maximum": 18.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 18.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 18.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abobotulinumtoxina 5 un", "drug_information": { "unit": 500.00, "type": "UN" }, "code_information": [ { "code": "J0586", "type": "HCPCS" }, { "code": "15054050001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8453.00, "discounted_cash": 5071.80, "minimum": 8.95, "maximum": 26.24, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 26.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 26.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 8.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Myobloc 2500 unit/0.5 ml inj", "drug_information": { "unit": 2500.00, "type": "UN" }, "code_information": [ { "code": "J0587", "type": "HCPCS" }, { "code": "10454071010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3048.00, "discounted_cash": 1828.80, "minimum": 12.87, "maximum": 37.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Myobloc 5000 unit / ml inj", "drug_information": { "unit": 5000.00, "type": "UN" }, "code_information": [ { "code": "J0587", "type": "HCPCS" }, { "code": "10454071110A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2179.00, "discounted_cash": 1307.40, "minimum": 12.87, "maximum": 37.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rimabotulinumtoxin b 10000 u", "drug_information": { "unit": 10000.00, "type": "UN" }, "code_information": [ { "code": "J0587", "type": "HCPCS" }, { "code": "10454071210", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4358.00, "discounted_cash": 2614.80, "minimum": 12.87, "maximum": 37.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xeomin 100 unit vial", "drug_information": { "unit": 100.00, "type": "UN" }, "code_information": [ { "code": "J0588", "type": "HCPCS" }, { "code": "00259161001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1771.00, "discounted_cash": 1062.60, "minimum": 5.28, "maximum": 15.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 15.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 15.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 5.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cinacalcet 30mg tab", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J0604", "type": "HCPCS" }, { "code": "64380088304A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 294.00, "discounted_cash": 176.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium gluconate injection", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0612", "type": "HCPCS" }, { "code": "63323036019a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 66.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 29.25, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcitonin sal inj 400unit/2ml", "drug_information": { "unit": 400.00, "type": "UN" }, "code_information": [ { "code": "J0630", "type": "HCPCS" }, { "code": "67457067502", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1299.00, "discounted_cash": 779.40, "minimum": 890.22, "maximum": 2610.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2610.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2610.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 890.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcitonin salmon 200mg/ml", "drug_information": { "unit": 200.00, "type": "UN" }, "code_information": [ { "code": "J0630", "type": "HCPCS" }, { "code": "69097077032", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7200.00, "discounted_cash": 4320.00, "minimum": 890.22, "maximum": 2610.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 2610.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 2610.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 890.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Caspofungin 50mg vial", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J0637", "type": "HCPCS" }, { "code": "72266010601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 646.00, "discounted_cash": 387.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leucovorin 200 mg", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J0640", "type": "HCPCS" }, { "code": "67457052920A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 461.00, "discounted_cash": 276.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exparel 266 mg / 20 ml inj", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J0666", "type": "HCPCS" }, { "code": "65250026620A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3629.00, "discounted_cash": 2177.40, "minimum": 1.26, "maximum": 3.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 10g vial", "drug_information": { "unit": 10.00, "type": "GM" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "00143998303A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 63.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.87, "10th_percentile": 8.98, "90th_percentile": 28.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 13.89, "10th_percentile": 12.63, "90th_percentile": 29.36, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 43.06, "10th_percentile": 29.62, "90th_percentile": 74.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.18, "10th_percentile": 35.97, "90th_percentile": 77.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 0-1000 mg (ancef)", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "00264310311", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 133.00, "discounted_cash": 79.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.87, "10th_percentile": 8.98, "90th_percentile": 28.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 13.89, "10th_percentile": 12.63, "90th_percentile": 29.36, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 43.06, "10th_percentile": 29.62, "90th_percentile": 74.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.18, "10th_percentile": 35.97, "90th_percentile": 77.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 2000 mg/50 ml dex pm", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "00264310511", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 90.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.87, "10th_percentile": 8.98, "90th_percentile": 28.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 13.89, "10th_percentile": 12.63, "90th_percentile": 29.36, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 43.06, "10th_percentile": 29.62, "90th_percentile": 74.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.18, "10th_percentile": 35.97, "90th_percentile": 77.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 1000 mg vantage", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "00409258501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 18.87, "10th_percentile": 8.98, "90th_percentile": 28.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 13.89, "10th_percentile": 12.63, "90th_percentile": 29.36, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 43.06, "10th_percentile": 29.62, "90th_percentile": 74.05, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 48.18, "10th_percentile": 35.97, "90th_percentile": 77.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 1000 mg 50 ml premix", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "00264319311", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 189.00, "discounted_cash": 113.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.23, "10th_percentile": 18.51, "90th_percentile": 61.79, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.06, "10th_percentile": 40.19, "90th_percentile": 89.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.95, "10th_percentile": 56.70, "90th_percentile": 140.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 2000 mg 50 ml premix", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "00264319511A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 287.00, "discounted_cash": 172.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.23, "10th_percentile": 18.51, "90th_percentile": 61.79, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.06, "10th_percentile": 40.19, "90th_percentile": 89.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.95, "10th_percentile": 56.70, "90th_percentile": 140.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 1 gram", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "44567024010A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 195.00, "discounted_cash": 117.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.23, "10th_percentile": 18.51, "90th_percentile": 61.79, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.06, "10th_percentile": 40.19, "90th_percentile": 89.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.95, "10th_percentile": 56.70, "90th_percentile": 140.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 2000 mg vial", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "25021012250a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 67.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.23, "10th_percentile": 18.51, "90th_percentile": 61.79, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.06, "10th_percentile": 40.19, "90th_percentile": 89.83, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 77.95, "10th_percentile": 56.70, "90th_percentile": 140.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rocephin 1 gm", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00409733201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 46.86, "10th_percentile": 4.52, "90th_percentile": 58.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 18.51, "10th_percentile": 4.77, "90th_percentile": 18.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.40, "10th_percentile": 41.77, "90th_percentile": 62.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.53, "10th_percentile": 51.66, "90th_percentile": 153.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rocephin 2 gm inj", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00409733503A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 72.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 46.86, "10th_percentile": 4.52, "90th_percentile": 58.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 18.51, "10th_percentile": 4.77, "90th_percentile": 18.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.40, "10th_percentile": 41.77, "90th_percentile": 62.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.53, "10th_percentile": 51.66, "90th_percentile": 153.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rocephin 250 mg inj", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00409733701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 46.86, "10th_percentile": 4.52, "90th_percentile": 58.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 18.51, "10th_percentile": 4.77, "90th_percentile": 18.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.40, "10th_percentile": 41.77, "90th_percentile": 62.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.53, "10th_percentile": 51.66, "90th_percentile": 153.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rocephin 500 mg inj", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00409733801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 46.86, "10th_percentile": 4.52, "90th_percentile": 58.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 18.51, "10th_percentile": 4.77, "90th_percentile": 18.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.40, "10th_percentile": 41.77, "90th_percentile": 62.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.53, "10th_percentile": 51.66, "90th_percentile": 153.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 1gm 50ml dup bag", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00264315311A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 189.00, "discounted_cash": 113.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 46.86, "10th_percentile": 4.52, "90th_percentile": 58.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 18.51, "10th_percentile": 4.77, "90th_percentile": 18.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.40, "10th_percentile": 41.77, "90th_percentile": 62.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.53, "10th_percentile": 51.66, "90th_percentile": 153.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 2gm 50ml dup bag", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00264315511", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 252.00, "discounted_cash": 151.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "26", "median_amount": 46.86, "10th_percentile": 4.52, "90th_percentile": 58.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 18.51, "10th_percentile": 4.77, "90th_percentile": 18.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 57.40, "10th_percentile": 41.77, "90th_percentile": 62.75, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 76.53, "10th_percentile": 51.66, "90th_percentile": 153.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zinacef 1500 mg", "drug_information": { "unit": 1.50, "type": "GM" }, "code_information": [ { "code": "J0697", "type": "HCPCS" }, { "code": "00143997722a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 33.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zinacef 750 mg injection", "drug_information": { "unit": 750.00, "type": "ME" }, "code_information": [ { "code": "J0697", "type": "HCPCS" }, { "code": "00143997922", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Betamethasone acetate 6mg/ml", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J0702", "type": "HCPCS" }, { "code": "00517072001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 122.00, "discounted_cash": 73.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fortaz 1 gm", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J0713", "type": "HCPCS" }, { "code": "00409508216a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.81, "10th_percentile": 8.81, "90th_percentile": 8.81, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fortaz 2 gm", "drug_information": { "unit": 2.00, "type": "GM" }, "code_information": [ { "code": "J0713", "type": "HCPCS" }, { "code": "00409508411a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 55.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.81, "10th_percentile": 8.81, "90th_percentile": 8.81, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clindamycin 900mg/50ml dext 5%", "drug_information": { "unit": 900.00, "type": "ME" }, "code_information": [ { "code": "J0736", "type": "HCPCS" }, { "code": "00781329009", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 174.00, "discounted_cash": 104.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cleocin 600 mg inj", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "J0736", "type": "HCPCS" }, { "code": "00009077526", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cleocin 300 mg/2ml inj", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "J0736", "type": "HCPCS" }, { "code": "00009087021A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cleocin 900 mg inj", "drug_information": { "unit": 900.00, "type": "ME" }, "code_information": [ { "code": "J0736", "type": "HCPCS" }, { "code": "00009090218", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ciprofloxacin 200mg pm", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J0744", "type": "HCPCS" }, { "code": "25021019282a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 17.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.23, "10th_percentile": 7.23, "90th_percentile": 14.46, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.39, "10th_percentile": 20.39, "90th_percentile": 26.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cipro 400mg iv pm", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "J0744", "type": "HCPCS" }, { "code": "25021011487a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 67.00, "discounted_cash": 40.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.23, "10th_percentile": 7.23, "90th_percentile": 14.46, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.39, "10th_percentile": 20.39, "90th_percentile": 26.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xiaflex 0.9mg vial", "drug_information": { "unit": 0.90, "type": "ME" }, "code_information": [ { "code": "J0775", "type": "HCPCS" }, { "code": "66887000301", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26588.00, "discounted_cash": 15952.80, "minimum": 72.65, "maximum": 212.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 212.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 212.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 72.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prochlorperazine 10mg/2ml", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J0780", "type": "HCPCS" }, { "code": "23155029442A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 32.16, "10th_percentile": 32.16, "90th_percentile": 32.16, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.18, "10th_percentile": 11.18, "90th_percentile": 11.18, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cortrosyn 0.25mg/2ml inj", "drug_information": { "unit": 0.25, "type": "ME" }, "code_information": [ { "code": "J0834", "type": "HCPCS" }, { "code": "00548590000", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1023.00, "discounted_cash": 613.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Crofab inj", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0840", "type": "HCPCS" }, { "code": "50633011012A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11081.00, "discounted_cash": 6648.60, "minimum": 1738.25, "maximum": 5096.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 5096.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 5096.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1738.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daptomycin 500mg vial iv med", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J0878", "type": "HCPCS" }, { "code": "00409012201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 758.00, "discounted_cash": 454.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 386.79, "10th_percentile": 386.79, "90th_percentile": 386.79, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procrit 10000 units (inj)", "drug_information": { "unit": 10000.00, "type": "UN" }, "code_information": [ { "code": "J0885", "type": "HCPCS" }, { "code": "59676031001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2566.00, "discounted_cash": 1539.60, "minimum": 7.01, "maximum": 20.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 20.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 20.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 7.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 748.30, "10th_percentile": 748.30, "90th_percentile": 748.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procrit 20000 units (inj)", "drug_information": { "unit": 20000.00, "type": "UN" }, "code_information": [ { "code": "J0885", "type": "HCPCS" }, { "code": "59676032004", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1883.00, "discounted_cash": 1129.80, "minimum": 7.01, "maximum": 20.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 20.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 20.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 7.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 748.30, "10th_percentile": 748.30, "90th_percentile": 748.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epoetin alfa 40000 units", "drug_information": { "unit": 40000.00, "type": "UN" }, "code_information": [ { "code": "J0885", "type": "HCPCS" }, { "code": "59676034001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10262.00, "discounted_cash": 6157.20, "minimum": 7.01, "maximum": 20.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 20.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 20.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 7.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 748.30, "10th_percentile": 748.30, "90th_percentile": 748.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Decitabine 50mg vial", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J0894", "type": "HCPCS" }, { "code": "43598042737", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4608.00, "discounted_cash": 2764.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Desferal 2gm inj", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J0895", "type": "HCPCS" }, { "code": "00409233725a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 391.00, "discounted_cash": 234.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prolia 60mg/ml prefill syr", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "J0897", "type": "HCPCS" }, { "code": "55513071001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6498.00, "discounted_cash": 3898.80, "minimum": 27.53, "maximum": 80.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1678.57, "10th_percentile": 1536.06, "90th_percentile": 1680.40, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 80.72, "count": "1 through 10", "median_amount": 3581.44, "10th_percentile": 3317.37, "90th_percentile": 3845.51, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 80.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1645.08, "10th_percentile": 1645.08, "90th_percentile": 1645.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 707.63, "10th_percentile": 600.72, "90th_percentile": 707.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27.53, "count": "1 through 10", "median_amount": 1663.59, "10th_percentile": 1412.48, "90th_percentile": 1708.45, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1727.34, "10th_percentile": 1727.34, "90th_percentile": 1727.34, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 1644.31, "10th_percentile": 1076.88, "90th_percentile": 2398.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1941.26, "10th_percentile": 1655.28, "90th_percentile": 2227.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xgeva 120mg 1.7ml vial", "drug_information": { "unit": 120.00, "type": "ME" }, "code_information": [ { "code": "J0897", "type": "HCPCS" }, { "code": "55513073001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7683.00, "discounted_cash": 4609.80, "minimum": 27.53, "maximum": 80.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1678.57, "10th_percentile": 1536.06, "90th_percentile": 1680.40, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 80.72, "count": "1 through 10", "median_amount": 3581.44, "10th_percentile": 3317.37, "90th_percentile": 3845.51, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 80.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1645.08, "10th_percentile": 1645.08, "90th_percentile": 1645.08, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 707.63, "10th_percentile": 600.72, "90th_percentile": 707.63, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27.53, "count": "1 through 10", "median_amount": 1663.59, "10th_percentile": 1412.48, "90th_percentile": 1708.45, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1727.34, "10th_percentile": 1727.34, "90th_percentile": 1727.34, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 1644.31, "10th_percentile": 1076.88, "90th_percentile": 2398.56, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1941.26, "10th_percentile": 1655.28, "90th_percentile": 2227.24, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Depoestradiol 5 mg/5ml", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "J1000", "type": "HCPCS" }, { "code": "00009027101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2476.00, "discounted_cash": 1485.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Depo medrol 40mg/ml vial", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009307303", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 109.00, "discounted_cash": 65.40, "minimum": 0.11, "maximum": 0.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 7.88, "10th_percentile": 1.89, "90th_percentile": 17.52, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 3.95, "10th_percentile": 0.65, "90th_percentile": 6.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.11, "count": "1 through 10", "median_amount": 2.34, "10th_percentile": 1.96, "90th_percentile": 2.72, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.23, "10th_percentile": 8.58, "90th_percentile": 12.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 8.59, "10th_percentile": 2.14, "90th_percentile": 22.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Depomedrol 80 mg/1ml inj", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009347501A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 189.00, "discounted_cash": 113.40, "minimum": 0.11, "maximum": 0.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 7.88, "10th_percentile": 1.89, "90th_percentile": 17.52, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 3.95, "10th_percentile": 0.65, "90th_percentile": 6.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.11, "count": "1 through 10", "median_amount": 2.34, "10th_percentile": 1.96, "90th_percentile": 2.72, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.23, "10th_percentile": 8.58, "90th_percentile": 12.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 8.59, "10th_percentile": 2.14, "90th_percentile": 22.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lasix 100mg 10ml", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "36000028425A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.00, "discounted_cash": 9.00, "minimum": 0.11, "maximum": 0.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 7.88, "10th_percentile": 1.89, "90th_percentile": 17.52, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 3.95, "10th_percentile": 0.65, "90th_percentile": 6.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.11, "count": "1 through 10", "median_amount": 2.34, "10th_percentile": 1.96, "90th_percentile": 2.72, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.23, "10th_percentile": 8.58, "90th_percentile": 12.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 8.59, "10th_percentile": 2.14, "90th_percentile": 22.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lasix 20 mg 2ml amp", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00409610202", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "minimum": 0.11, "maximum": 0.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 7.88, "10th_percentile": 1.89, "90th_percentile": 17.52, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 3.95, "10th_percentile": 0.65, "90th_percentile": 6.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.11, "count": "1 through 10", "median_amount": 2.34, "10th_percentile": 1.96, "90th_percentile": 2.72, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.23, "10th_percentile": 8.58, "90th_percentile": 12.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 8.59, "10th_percentile": 2.14, "90th_percentile": 22.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lasix 40 mg 4 ml amp", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00409610204", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "minimum": 0.11, "maximum": 0.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 1.89, "10th_percentile": 0.99, "90th_percentile": 2.79, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 7.88, "10th_percentile": 1.89, "90th_percentile": 17.52, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "30", "median_amount": 3.95, "10th_percentile": 0.65, "90th_percentile": 6.10, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.11, "count": "1 through 10", "median_amount": 2.34, "10th_percentile": 1.96, "90th_percentile": 2.72, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 12.23, "10th_percentile": 8.58, "90th_percentile": 12.48, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "34", "median_amount": 8.59, "10th_percentile": 2.14, "90th_percentile": 22.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Depo provera 150 mg/ml", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "J1050", "type": "HCPCS" }, { "code": "00548570100a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 144.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Depo testosterone 200 mg/ml", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J1071", "type": "HCPCS" }, { "code": "00009041701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 228.00, "discounted_cash": 136.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Decadron 4 mg/1ml inj", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "J1100", "type": "HCPCS" }, { "code": "63323016501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 16.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 22.32, "10th_percentile": 13.40, "90th_percentile": 22.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 7.76, "10th_percentile": 5.44, "90th_percentile": 15.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.32, "10th_percentile": 22.32, "90th_percentile": 22.32, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 17.51, "10th_percentile": 10.63, "90th_percentile": 35.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 19.58, "10th_percentile": 6.04, "90th_percentile": 24.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 10mg/ml pf inj", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J1100", "type": "HCPCS" }, { "code": "63323050601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 72.00, "discounted_cash": 43.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 22.32, "10th_percentile": 13.40, "90th_percentile": 22.32, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "27", "median_amount": 7.76, "10th_percentile": 5.44, "90th_percentile": 15.52, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.32, "10th_percentile": 22.32, "90th_percentile": 22.32, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 17.51, "10th_percentile": 10.63, "90th_percentile": 35.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 19.58, "10th_percentile": 6.04, "90th_percentile": 24.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diamox 500 mg inj", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J1120", "type": "HCPCS" }, { "code": "39822019001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 302.00, "discounted_cash": 181.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Digoxin .5 mg 2 ml amp", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "J1160", "type": "HCPCS" }, { "code": "00781305995A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 72.00, "discounted_cash": 43.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.76, "10th_percentile": 7.76, "90th_percentile": 7.76, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Digibind 38 mg inj", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J1162", "type": "HCPCS" }, { "code": "87131012012a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16573.00, "discounted_cash": 9943.80, "minimum": 4918.89, "maximum": 14421.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 14421.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 14421.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4918.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydromorphone 1 mg/1ml inj", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409128331", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 63.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.50, "10th_percentile": 13.02, "90th_percentile": 17.98, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.51, "10th_percentile": 2.45, "90th_percentile": 15.54, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 8.89, "10th_percentile": 6.84, "90th_percentile": 64.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.78, "10th_percentile": 8.76, "90th_percentile": 10.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dilaudid 2 mg/1ml inj", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409131230", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 92.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.50, "10th_percentile": 13.02, "90th_percentile": 17.98, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.51, "10th_percentile": 2.45, "90th_percentile": 15.54, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 8.89, "10th_percentile": 6.84, "90th_percentile": 64.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.78, "10th_percentile": 8.76, "90th_percentile": 10.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Benadryl 50 mg 1 ml inj", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J1200", "type": "HCPCS" }, { "code": "76045010210A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.20, "10th_percentile": 5.27, "90th_percentile": 10.85, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dobutamine hcl 250 mg premix", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J1250", "type": "HCPCS" }, { "code": "00338107302a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 129.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dopamine 400mg/10ml vial", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "J1265", "type": "HCPCS" }, { "code": "00409910421", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leqvio injection 284mg", "drug_information": { "unit": 284.00, "type": "ME" }, "code_information": [ { "code": "J1306", "type": "HCPCS" }, { "code": "00078100060", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12074.00, "discounted_cash": 7244.40, "minimum": 10.91, "maximum": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 32.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 32.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 10.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eptifibatide 200mg/100ml vial", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J1327", "type": "HCPCS" }, { "code": "55150022099a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5760.00, "discounted_cash": 3456.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Integrilin 2mg/ml 10ml iv solu", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J1327", "type": "HCPCS" }, { "code": "70436002680a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1462.00, "discounted_cash": 877.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Invanz 1000 mg", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J1335", "type": "HCPCS" }, { "code": "42023022110a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1124.00, "discounted_cash": 674.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injectafer 750 mg 15 ml inj", "drug_information": { "unit": 750.00, "type": "ME" }, "code_information": [ { "code": "J1439", "type": "HCPCS" }, { "code": "00517065001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3966.00, "discounted_cash": 2379.60, "minimum": 1.12, "maximum": 3.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 3.28, "count": "1 through 10", "median_amount": 1857.92, "10th_percentile": 913.74, "90th_percentile": 2316.54, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 3.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 333.14, "10th_percentile": 333.14, "90th_percentile": 333.14, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diflucan 200mg iv pm", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J1450", "type": "HCPCS" }, { "code": "25021018482a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 86.00, "discounted_cash": 51.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fomepizole 1500mg/1.5ml", "drug_information": { "unit": 1500.00, "type": "ME" }, "code_information": [ { "code": "J1451", "type": "HCPCS" }, { "code": "70710147801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17280.00, "discounted_cash": 10368.00, "minimum": 6.10, "maximum": 17.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 17.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 17.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emend fosaprepitant 150mg vial", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "J1453", "type": "HCPCS" }, { "code": "00006306100A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3084.00, "discounted_cash": 1850.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Palonosetron 0.25 mg inj", "drug_information": { "unit": 0.25, "type": "ME" }, "code_information": [ { "code": "J1454", "type": "HCPCS" }, { "code": "63323067305a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 129.60, "minimum": 626.55, "maximum": 1837.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1837.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1837.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.28, "10th_percentile": 21.59, "90th_percentile": 34.76, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 626.55, "count": "1 through 10", "median_amount": 66.29, "10th_percentile": 66.29, "90th_percentile": 66.29, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 65.63, "10th_percentile": 65.63, "90th_percentile": 65.63, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj ivig privigen 500 mg", "code_information": [ { "code": "J1459", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 99.60, "minimum": 48.69, "maximum": 142.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1255.63, "10th_percentile": 284.06, "90th_percentile": 2227.19, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 142.75, "count": "11", "median_amount": 13966.84, "10th_percentile": 13293.74, "90th_percentile": 14059.31, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 142.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 666.99, "10th_percentile": 303.94, "90th_percentile": 1073.69, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 48.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Privigen iv per 1 gm", "code_information": [ { "code": "J1459", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 99.60, "minimum": 48.69, "maximum": 142.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1255.63, "10th_percentile": 284.06, "90th_percentile": 2227.19, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 142.75, "count": "11", "median_amount": 13966.84, "10th_percentile": 13293.74, "90th_percentile": 14059.31, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 142.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 666.99, "10th_percentile": 303.94, "90th_percentile": 1073.69, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 48.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Octagam injection", "code_information": [ { "code": "J1568", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 120.50, "discounted_cash": 72.30, "minimum": 47.58, "maximum": 139.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Octagam per 25gm", "code_information": [ { "code": "J1568", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 120.50, "discounted_cash": 72.30, "minimum": 47.58, "maximum": 139.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 139.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 139.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 47.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gentamicin sulfate pf 20 mg", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J1580", "type": "HCPCS" }, { "code": "63323017302", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 22.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.49, "10th_percentile": 3.06, "90th_percentile": 13.93, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Garamycin 80 mg 2 ml vl", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "J1580", "type": "HCPCS" }, { "code": "00409120703", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.49, "10th_percentile": 3.06, "90th_percentile": 13.93, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucagon 1 unit inj", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J1610", "type": "HCPCS" }, { "code": "00548585000A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2688.00, "discounted_cash": 1612.80, "minimum": 188.85, "maximum": 553.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 553.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 553.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 188.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haldol 5 mg/ml inj", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "J1630", "type": "HCPCS" }, { "code": "63323047401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heparin sodium 100 unit/ml 5ml", "drug_information": { "unit": 500.00, "type": "UN" }, "code_information": [ { "code": "J1642", "type": "HCPCS" }, { "code": "08290306424a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1.08, "10th_percentile": 1.01, "90th_percentile": 1.70, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2.43, "10th_percentile": 2.43, "90th_percentile": 2.43, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heparin 5000 1 ml", "drug_information": { "unit": 5000.00, "type": "UN" }, "code_information": [ { "code": "J1644", "type": "HCPCS" }, { "code": "25021040201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 7.19, "10th_percentile": 3.60, "90th_percentile": 13.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "44", "median_amount": 1.57, "10th_percentile": 1.42, "90th_percentile": 16.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.61, "10th_percentile": 4.41, "90th_percentile": 45.64, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 4.41, "10th_percentile": 3.53, "90th_percentile": 45.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 13.36, "10th_percentile": 5.64, "90th_percentile": 121.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 13.36, "10th_percentile": 5.64, "90th_percentile": 121.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.39, "10th_percentile": 4.93, "90th_percentile": 51.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 25.86, "90th_percentile": 125.90, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 25.86, "90th_percentile": 125.90, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Heparin d5w 25000 unit premix", "drug_information": { "unit": 25000.00, "type": "UN" }, "code_information": [ { "code": "J1644", "type": "HCPCS" }, { "code": "00264958720", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 90.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 7.19, "10th_percentile": 3.60, "90th_percentile": 13.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "44", "median_amount": 1.57, "10th_percentile": 1.42, "90th_percentile": 16.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.61, "10th_percentile": 4.41, "90th_percentile": 45.64, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 4.41, "10th_percentile": 3.53, "90th_percentile": 45.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 13.36, "10th_percentile": 5.64, "90th_percentile": 121.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 13.36, "10th_percentile": 5.64, "90th_percentile": 121.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.39, "10th_percentile": 4.93, "90th_percentile": 51.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 25.86, "90th_percentile": 125.90, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 25.86, "90th_percentile": 125.90, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Heparin sodium 0.45 ns 100u", "drug_information": { "unit": 25000.00, "type": "UN" }, "code_information": [ { "code": "J1644", "type": "HCPCS" }, { "code": "63323051774a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 62.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "38", "median_amount": 7.19, "10th_percentile": 3.60, "90th_percentile": 13.49, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "44", "median_amount": 1.57, "10th_percentile": 1.42, "90th_percentile": 16.19, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.61, "10th_percentile": 4.41, "90th_percentile": 45.64, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "42", "median_amount": 4.41, "10th_percentile": 3.53, "90th_percentile": 45.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 13.36, "10th_percentile": 5.64, "90th_percentile": 121.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 13.36, "10th_percentile": 5.64, "90th_percentile": 121.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.39, "10th_percentile": 4.93, "90th_percentile": 51.09, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 25.86, "90th_percentile": 125.90, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 75.88, "10th_percentile": 25.86, "90th_percentile": 125.90, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lovenox 80 mg syringe", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00075801810A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 98.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.37, "10th_percentile": 8.37, "90th_percentile": 19.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 2.91, "10th_percentile": 1.78, "90th_percentile": 13.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.89, "10th_percentile": 7.88, "90th_percentile": 40.02, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 18.17, "10th_percentile": 4.39, "90th_percentile": 107.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.70, "10th_percentile": 42.58, "90th_percentile": 164.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lovenox 100 mg inj", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00075802001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 86.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.37, "10th_percentile": 8.37, "90th_percentile": 19.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 2.91, "10th_percentile": 1.78, "90th_percentile": 13.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.89, "10th_percentile": 7.88, "90th_percentile": 40.02, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 18.17, "10th_percentile": 4.39, "90th_percentile": 107.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.70, "10th_percentile": 42.58, "90th_percentile": 164.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lovenox 30mg/0.3ml", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00548560100a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 25.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.37, "10th_percentile": 8.37, "90th_percentile": 19.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 2.91, "10th_percentile": 1.78, "90th_percentile": 13.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.89, "10th_percentile": 7.88, "90th_percentile": 40.02, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 18.17, "10th_percentile": 4.39, "90th_percentile": 107.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.70, "10th_percentile": 42.58, "90th_percentile": 164.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lovenox 60 mg inj", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00548560300a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 86.00, "discounted_cash": 51.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.37, "10th_percentile": 8.37, "90th_percentile": 19.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 2.91, "10th_percentile": 1.78, "90th_percentile": 13.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.89, "10th_percentile": 7.88, "90th_percentile": 40.02, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 18.17, "10th_percentile": 4.39, "90th_percentile": 107.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.70, "10th_percentile": 42.58, "90th_percentile": 164.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lovenox 150mg/1ml syringe", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "71839011610a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 403.00, "discounted_cash": 241.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.37, "10th_percentile": 8.37, "90th_percentile": 19.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 2.91, "10th_percentile": 1.78, "90th_percentile": 13.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.89, "10th_percentile": 7.88, "90th_percentile": 40.02, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 18.17, "10th_percentile": 4.39, "90th_percentile": 107.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.70, "10th_percentile": 42.58, "90th_percentile": 164.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lovenox 40 mg syringe", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "71288043392a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 16.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.37, "10th_percentile": 8.37, "90th_percentile": 19.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "36", "median_amount": 2.91, "10th_percentile": 1.78, "90th_percentile": 13.39, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 21.89, "10th_percentile": 7.88, "90th_percentile": 40.02, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 18.17, "10th_percentile": 4.39, "90th_percentile": 107.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 81.70, "10th_percentile": 42.58, "90th_percentile": 164.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fondaparinux 2.5 mg / 0.5ml", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "J1652", "type": "HCPCS" }, { "code": "55111067802A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 554.00, "discounted_cash": 332.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fondaparinux 10 mg / 0.8ml inj", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J1652", "type": "HCPCS" }, { "code": "55111068102", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 382.00, "discounted_cash": 229.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tet imm glob 250ou tubex", "drug_information": { "unit": 250.00, "type": "UN" }, "code_information": [ { "code": "J1670", "type": "HCPCS" }, { "code": "13533063402", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1152.00, "discounted_cash": 691.20, "minimum": 570.00, "maximum": 1671.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1671.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1671.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 570.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Solu cortef 100 mg inj", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1720", "type": "HCPCS" }, { "code": "00009001103", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 243.00, "discounted_cash": 145.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Solu cortef 250 mg inj", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J1720", "type": "HCPCS" }, { "code": "00009001305", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 492.00, "discounted_cash": 295.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ibandronate sodium 3mg/3ml inj", "drug_information": { "unit": 3.00, "type": "ME" }, "code_information": [ { "code": "J1740", "type": "HCPCS" }, { "code": "25021082761a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 501.00, "discounted_cash": 300.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Icatabant acetate firazyr 30", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J1744", "type": "HCPCS" }, { "code": "54092070202", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33753.00, "discounted_cash": 20251.80, "minimum": 124.07, "maximum": 363.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 363.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 363.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 124.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remicaide 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1745", "type": "HCPCS" }, { "code": "57894003001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3467.00, "discounted_cash": 2080.20, "minimum": 30.21, "maximum": 88.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 88.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 88.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 30.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 711.12, "10th_percentile": 214.20, "90th_percentile": 1889.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remicaide 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1745", "type": "HCPCS" }, { "code": "57894003001B", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11211.00, "discounted_cash": 6726.60, "minimum": 30.21, "maximum": 88.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 88.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 88.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 30.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 711.12, "10th_percentile": 214.20, "90th_percentile": 1889.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Infliximab 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1745", "type": "HCPCS" }, { "code": "57894016001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1410.00, "discounted_cash": 846.00, "minimum": 30.21, "maximum": 88.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 88.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 88.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 30.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 711.12, "10th_percentile": 214.20, "90th_percentile": 1889.19, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iron dextran 100mg/2ml vial iv", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1750", "type": "HCPCS" }, { "code": "00023608210A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 225.60, "minimum": 17.06, "maximum": 50.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 50.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 50.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 17.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venofer 100 mg per 5 ml", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J1756", "type": "HCPCS" }, { "code": "00517234010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 624.00, "discounted_cash": 374.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 450.40, "10th_percentile": 450.40, "90th_percentile": 450.40, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 303.08, "10th_percentile": 303.08, "90th_percentile": 666.78, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 339.20, "10th_percentile": 339.20, "90th_percentile": 339.20, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Droperidol 2.5 mg / 1ml vial", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "J1790", "type": "HCPCS" }, { "code": "00517970201a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inderal 1 mg/ml inj", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J1800", "type": "HCPCS" }, { "code": "00143987210a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 46.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tresiba 1 unit/0.01ml", "drug_information": { "unit": 1.00, "type": "UN" }, "code_information": [ { "code": "J1815", "type": "HCPCS" }, { "code": "00169266211", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 1.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toradol 30 mg inj", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "00409379519A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "minimum": 0.44, "maximum": 1.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4.50, "10th_percentile": 2.45, "90th_percentile": 4.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4.50, "10th_percentile": 2.45, "90th_percentile": 4.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 1.55, "10th_percentile": 0.78, "90th_percentile": 2.33, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1.30, "count": "66", "median_amount": 4.21, "10th_percentile": 1.77, "90th_percentile": 6.31, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "74", "median_amount": 0.49, "10th_percentile": 0.27, "90th_percentile": 0.73, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.44, "count": "12", "median_amount": 1.53, "10th_percentile": 0.77, "90th_percentile": 2.30, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 1.55, "10th_percentile": 0.91, "90th_percentile": 2.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "62", "median_amount": 1.52, "10th_percentile": 0.77, "90th_percentile": 2.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4.61, "10th_percentile": 2.76, "90th_percentile": 6.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4.61, "10th_percentile": 2.76, "90th_percentile": 6.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "44", "median_amount": 1.70, "10th_percentile": 0.68, "90th_percentile": 2.40, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3.69, "10th_percentile": 2.21, "90th_percentile": 5.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3.69, "10th_percentile": 2.21, "90th_percentile": 5.16, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Toradol 60 mg inj", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "00409379619A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "minimum": 0.44, "maximum": 1.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4.50, "10th_percentile": 2.45, "90th_percentile": 4.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 4.50, "10th_percentile": 2.45, "90th_percentile": 4.65, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 1.55, "10th_percentile": 0.78, "90th_percentile": 2.33, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1.30, "count": "66", "median_amount": 4.21, "10th_percentile": 1.77, "90th_percentile": 6.31, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "74", "median_amount": 0.49, "10th_percentile": 0.27, "90th_percentile": 0.73, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.44, "count": "12", "median_amount": 1.53, "10th_percentile": 0.77, "90th_percentile": 2.30, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 1.55, "10th_percentile": 0.91, "90th_percentile": 2.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "62", "median_amount": 1.52, "10th_percentile": 0.77, "90th_percentile": 2.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4.61, "10th_percentile": 2.76, "90th_percentile": 6.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 4.61, "10th_percentile": 2.76, "90th_percentile": 6.45, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "44", "median_amount": 1.70, "10th_percentile": 0.68, "90th_percentile": 2.40, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3.69, "10th_percentile": 2.21, "90th_percentile": 5.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 3.69, "10th_percentile": 2.21, "90th_percentile": 5.16, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lanreotide 120mg/0.5ml", "drug_information": { "unit": 120.00, "type": "ME" }, "code_information": [ { "code": "J1932", "type": "HCPCS" }, { "code": "69097090667A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21780.00, "discounted_cash": 13068.00, "minimum": 22.61, "maximum": 66.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 66.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 66.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 22.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lupron 3.75 mg", "drug_information": { "unit": 3.75, "type": "ME" }, "code_information": [ { "code": "J1950", "type": "HCPCS" }, { "code": "00074364103B", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5873.00, "discounted_cash": 3523.80, "minimum": 1653.60, "maximum": 4848.21, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4848.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4848.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1653.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lupron 7.5 mg", "drug_information": { "unit": 7.50, "type": "ME" }, "code_information": [ { "code": "J1950", "type": "HCPCS" }, { "code": "00074364203A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6999.00, "discounted_cash": 4199.40, "minimum": 1653.60, "maximum": 4848.21, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 4848.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 4848.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 1653.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levetiracetam 500mg 5ml vial", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J1953", "type": "HCPCS" }, { "code": "00409188602", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 37.00, "discounted_cash": 22.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 22.69, "10th_percentile": 13.62, "90th_percentile": 31.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5.08, "10th_percentile": 4.26, "90th_percentile": 5.90, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levofloxacin 250mg/50ml in d5w", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J1956", "type": "HCPCS" }, { "code": "00409222001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 34.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.26, "10th_percentile": 38.26, "90th_percentile": 38.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levofloxacin 500 mg 100ml d5w", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J1956", "type": "HCPCS" }, { "code": "00409333001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 35.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.26, "10th_percentile": 38.26, "90th_percentile": 38.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levofloxacin 750mg/150ml/d5w", "drug_information": { "unit": 750.00, "type": "ME" }, "code_information": [ { "code": "J1956", "type": "HCPCS" }, { "code": "00143972001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 126.00, "discounted_cash": 75.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 38.26, "10th_percentile": 38.26, "90th_percentile": 38.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine 2000mg 1500ml d5w", "drug_information": { "unit": 2000.00, "type": "ME" }, "code_information": [ { "code": "J2002", "type": "HCPCS" }, { "code": "00264959410", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 46.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine hci 1000mg 250ml pm", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "00264959420A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 46.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xylocaine 1% 20ml vial", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "00409427601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 18.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidocaine hci 1% plain", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "00409427601A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 18.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidocaine 2% 50ml vial", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "00409427702", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidocaine 1% 5ml amp", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "00409471312a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidocane hci 1% mpf 30 ml vial", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "63323049207", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 98.00, "discounted_cash": 58.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xylocaine 1% mpf 2ml vial", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "63323049227", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lidocaine 2% gel 10 ml urojet", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J2003", "type": "HCPCS" }, { "code": "76329301305", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 68.00, "discounted_cash": 40.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 9.46, "10th_percentile": 6.47, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "45", "median_amount": 3.29, "10th_percentile": 2.80, "90th_percentile": 3.29, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.42, "10th_percentile": 3.77, "90th_percentile": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "43", "median_amount": 7.42, "10th_percentile": 5.07, "90th_percentile": 9.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 22.48, "10th_percentile": 22.48, "90th_percentile": 22.48, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 8.30, "10th_percentile": 8.30, "90th_percentile": 10.37, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 25.29, "10th_percentile": 23.04, "90th_percentile": 27.54, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xylocaine/epi vl 1% 20ml", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J2004", "type": "HCPCS" }, { "code": "63323048203A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine 1% epi 1:100000 50", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J2004", "type": "HCPCS" }, { "code": "00409317803A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 125.00, "discounted_cash": 75.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Linezolid 600 mg premix", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "J2020", "type": "HCPCS" }, { "code": "57664068331", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 600.00, "discounted_cash": 360.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 306.00, "10th_percentile": 224.40, "90th_percentile": 387.60, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lorazepam 2mg/ml vial", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J2060", "type": "HCPCS" }, { "code": "00641604425", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 5.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 0.93, "10th_percentile": 0.93, "90th_percentile": 0.93, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2.90, "10th_percentile": 2.90, "90th_percentile": 2.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lorazepam 20mg 20ml vial", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J2060", "type": "HCPCS" }, { "code": "00641604610a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 0.93, "10th_percentile": 0.93, "90th_percentile": 0.93, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2.90, "10th_percentile": 2.90, "90th_percentile": 2.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Demerol 25 mg inj", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "J2175", "type": "HCPCS" }, { "code": "00409117630", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 211.00, "discounted_cash": 126.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nucala 100mg syringe", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J2182", "type": "HCPCS" }, { "code": "00173089242A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10574.00, "discounted_cash": 6344.40, "minimum": 30.23, "maximum": 88.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 88.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 88.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 30.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meplizumab (nucala) 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J2182", "type": "HCPCS" }, { "code": "00173088101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9013.00, "discounted_cash": 5407.80, "minimum": 30.23, "maximum": 88.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 88.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 88.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 30.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 1gm/50ml ns premix", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "00264318511", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 287.00, "discounted_cash": 172.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.66, "10th_percentile": 6.78, "90th_percentile": 92.86, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.51, "10th_percentile": 23.51, "90th_percentile": 23.51, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 500 mg vial", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "55150020720a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.66, "10th_percentile": 6.78, "90th_percentile": 92.86, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.51, "10th_percentile": 23.51, "90th_percentile": 23.51, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 1 gm vial", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "55150020830a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 127.00, "discounted_cash": 76.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.66, "10th_percentile": 6.78, "90th_percentile": 92.86, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.51, "10th_percentile": 23.51, "90th_percentile": 23.51, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methergine 0.2 mg 1ml inj", "drug_information": { "unit": 0.20, "type": "ME" }, "code_information": [ { "code": "J2210", "type": "HCPCS" }, { "code": "63704000401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 103.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycamine 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J2248", "type": "HCPCS" }, { "code": "70594003701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1795.00, "discounted_cash": 1077.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Midazolam 50mg/10ml vial", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J2250", "type": "HCPCS" }, { "code": "00409259605", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 162.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1.32, "10th_percentile": 0.62, "90th_percentile": 2.33, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 0.68, "10th_percentile": 0.26, "90th_percentile": 0.81, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 7.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 1.52, "10th_percentile": 0.61, "90th_percentile": 2.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 2.72, "10th_percentile": 1.09, "90th_percentile": 8.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Versed 2mg", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J2250", "type": "HCPCS" }, { "code": "00641605701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1.32, "10th_percentile": 0.62, "90th_percentile": 2.33, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "54", "median_amount": 0.68, "10th_percentile": 0.26, "90th_percentile": 0.81, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 7.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "40", "median_amount": 1.52, "10th_percentile": 0.61, "90th_percentile": 2.29, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "17", "median_amount": 2.72, "10th_percentile": 1.09, "90th_percentile": 8.16, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine sulfate 4mg/ml vial", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "J2270", "type": "HCPCS" }, { "code": "00641612525", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.90, "10th_percentile": 6.90, "90th_percentile": 6.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2.38, "10th_percentile": 2.35, "90th_percentile": 2.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 7.30, "10th_percentile": 6.77, "90th_percentile": 7.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine sulfate 10 mg 1 ml", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J2270", "type": "HCPCS" }, { "code": "00641612701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.90, "10th_percentile": 6.90, "90th_percentile": 6.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2.38, "10th_percentile": 2.35, "90th_percentile": 2.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 7.30, "10th_percentile": 6.77, "90th_percentile": 7.30, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duramorph 10mg/10ml amp", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J2274", "type": "HCPCS" }, { "code": "00641601901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 209.00, "discounted_cash": 125.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 6.03, "10th_percentile": 2.21, "90th_percentile": 18.82, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.24, "10th_percentile": 6.24, "90th_percentile": 6.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.61, "10th_percentile": 13.94, "90th_percentile": 88.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine sulfate 2mg/1ml syg", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J2274", "type": "HCPCS" }, { "code": "00409189001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 6.03, "10th_percentile": 2.21, "90th_percentile": 18.82, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.24, "10th_percentile": 6.24, "90th_percentile": 6.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 39.61, "10th_percentile": 13.94, "90th_percentile": 88.13, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Narcan 0.4 mg 1ml inj", "drug_information": { "unit": 0.40, "type": "ME" }, "code_information": [ { "code": "J2312", "type": "HCPCS" }, { "code": "00409121501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 152.00, "discounted_cash": 91.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.69, "10th_percentile": 54.28, "90th_percentile": 64.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Narcan 2mg/2ml", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J2312", "type": "HCPCS" }, { "code": "76329336901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 380.00, "discounted_cash": 228.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 64.69, "10th_percentile": 54.28, "90th_percentile": 64.69, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ocrelizumab 1 mg inj", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "J2350", "type": "HCPCS" }, { "code": "50242015001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61923.00, "discounted_cash": 37153.80, "minimum": 57.23, "maximum": 167.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 167.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 167.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 57.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Octreotide 20 mg inj", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J2353", "type": "HCPCS" }, { "code": "00078081881A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15374.00, "discounted_cash": 9224.40, "minimum": 202.54, "maximum": 593.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 593.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 593.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 202.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5101.07, "10th_percentile": 4787.14, "90th_percentile": 5414.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Octreotide 30mg lar", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J2353", "type": "HCPCS" }, { "code": "00078082581A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22128.00, "discounted_cash": 13276.80, "minimum": 202.54, "maximum": 593.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 593.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 593.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 202.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5101.07, "10th_percentile": 4787.14, "90th_percentile": 5414.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tezspire 210mg/1.91ml syr", "drug_information": { "unit": 210.00, "type": "ME" }, "code_information": [ { "code": "J2356", "type": "HCPCS" }, { "code": "55513011201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16056.00, "discounted_cash": 9633.60, "minimum": 15.81, "maximum": 46.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 46.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 46.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 15.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xolair 75mg/0.5 ml syringe", "drug_information": { "unit": 75.00, "type": "ME" }, "code_information": [ { "code": "J2357", "type": "HCPCS" }, { "code": "50242021403a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7458.00, "discounted_cash": 4474.80, "minimum": 39.72, "maximum": 116.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 116.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 116.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 39.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xolair 150mg/ml syringe", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "J2357", "type": "HCPCS" }, { "code": "50242021503a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 2277.60, "minimum": 39.72, "maximum": 116.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 116.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 116.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 39.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Omalizumab xolair 150mg vial", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "J2357", "type": "HCPCS" }, { "code": "50242004062", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3309.00, "discounted_cash": 1985.40, "minimum": 39.72, "maximum": 116.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 116.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 116.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 39.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ondansetron 40mg 20ml multi", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J2405", "type": "HCPCS" }, { "code": "00641607901a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.10, "10th_percentile": 3.10, "90th_percentile": 4.96, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 0.98, "10th_percentile": 0.98, "90th_percentile": 1.08, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.10, "10th_percentile": 3.10, "90th_percentile": 3.10, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 3.04, "10th_percentile": 3.04, "90th_percentile": 3.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.40, "10th_percentile": 2.72, "90th_percentile": 6.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ondasetron 4mg/2ml injection", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "J2405", "type": "HCPCS" }, { "code": "00409475518", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.10, "10th_percentile": 3.10, "90th_percentile": 4.96, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "35", "median_amount": 0.98, "10th_percentile": 0.98, "90th_percentile": 1.08, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.10, "10th_percentile": 3.10, "90th_percentile": 3.10, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "33", "median_amount": 3.04, "10th_percentile": 3.04, "90th_percentile": 3.04, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1.36, "10th_percentile": 1.36, "90th_percentile": 1.36, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3.40, "10th_percentile": 2.72, "90th_percentile": 6.80, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orbactiv 400 mg pds", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "J2407", "type": "HCPCS" }, { "code": "70842014003A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3438.00, "discounted_cash": 2062.80, "minimum": 28.24, "maximum": 82.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 82.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 82.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 28.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pamidronate disodium per 30 mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J2430", "type": "HCPCS" }, { "code": "61703032418", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 83.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pamidronate 90mg/10ml vial", "drug_information": { "unit": 90.00, "type": "ME" }, "code_information": [ { "code": "J2430", "type": "HCPCS" }, { "code": "61703032618A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 360.00, "discounted_cash": 216.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protonix 40 mg iv", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J2471", "type": "HCPCS" }, { "code": "00008092355a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 172.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.42, "10th_percentile": 71.42, "90th_percentile": 124.99, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "23", "median_amount": 31.05, "10th_percentile": 28.22, "90th_percentile": 62.09, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 174.99, "10th_percentile": 174.99, "90th_percentile": 174.99, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 87.50, "10th_percentile": 87.50, "90th_percentile": 209.99, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 97.92, "10th_percentile": 89.11, "90th_percentile": 168.42, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pegfilgrastim onpro 6mg", "drug_information": { "unit": 6.00, "type": "ME" }, "code_information": [ { "code": "J2506", "type": "HCPCS" }, { "code": "55513019201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14765.00, "discounted_cash": 8859.00, "minimum": 19.78, "maximum": 57.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 57.99, "count": "1 through 10", "median_amount": 16657.05, "10th_percentile": 16657.05, "90th_percentile": 16657.05, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 57.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1886.89, "10th_percentile": 1886.89, "90th_percentile": 1886.89, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6824.26, "10th_percentile": 6824.26, "90th_percentile": 6824.26, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Krystexxa 8mg ml", "drug_information": { "unit": 8.00, "type": "ME" }, "code_information": [ { "code": "J2507", "type": "HCPCS" }, { "code": "75987008010A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 120090.00, "discounted_cash": 72054.00, "minimum": 3529.67, "maximum": 10348.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 10348.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 10348.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3529.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenobarb 130 mg 1ml inj", "drug_information": { "unit": 130.00, "type": "ME" }, "code_information": [ { "code": "J2515", "type": "HCPCS" }, { "code": "00641047725", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 442.00, "discounted_cash": 265.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pipercillin/tazobactam2.25g/50", "drug_information": { "unit": 2.25, "type": "GM" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "00264344611", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 169.00, "discounted_cash": 101.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 181.24, "10th_percentile": 84.15, "90th_percentile": 242.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 25.91, "10th_percentile": 3.72, "90th_percentile": 77.75, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.44, "10th_percentile": 50.74, "90th_percentile": 80.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 66.62, "10th_percentile": 63.44, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.00, "10th_percentile": 71.00, "90th_percentile": 141.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pipercillin/tazobactam3.375/50", "drug_information": { "unit": 3.38, "type": "GM" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "00264344811", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 219.00, "discounted_cash": 131.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 181.24, "10th_percentile": 84.15, "90th_percentile": 242.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 25.91, "10th_percentile": 3.72, "90th_percentile": 77.75, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.44, "10th_percentile": 50.74, "90th_percentile": 80.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 66.62, "10th_percentile": 63.44, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.00, "10th_percentile": 71.00, "90th_percentile": 141.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pipercillin/tazobactam4.5g/100", "drug_information": { "unit": 4.50, "type": "GM" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "00264345022", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 270.00, "discounted_cash": 162.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 181.24, "10th_percentile": 84.15, "90th_percentile": 242.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 25.91, "10th_percentile": 3.72, "90th_percentile": 77.75, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.44, "10th_percentile": 50.74, "90th_percentile": 80.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 66.62, "10th_percentile": 63.44, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.00, "10th_percentile": 71.00, "90th_percentile": 141.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pipercillin/tazobactam 2.25gm", "drug_information": { "unit": 2.25, "type": "GM" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "55150011930a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 181.24, "10th_percentile": 84.15, "90th_percentile": 242.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 25.91, "10th_percentile": 3.72, "90th_percentile": 77.75, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.44, "10th_percentile": 50.74, "90th_percentile": 80.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 66.62, "10th_percentile": 63.44, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.00, "10th_percentile": 71.00, "90th_percentile": 141.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zosyn 3.375 gm inj", "drug_information": { "unit": 3.38, "type": "GM" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "55150012030a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 209.00, "discounted_cash": 125.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 181.24, "10th_percentile": 84.15, "90th_percentile": 242.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 25.91, "10th_percentile": 3.72, "90th_percentile": 77.75, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.44, "10th_percentile": 50.74, "90th_percentile": 80.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 66.62, "10th_percentile": 63.44, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.00, "10th_percentile": 71.00, "90th_percentile": 141.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zosyn 4.5gm vial", "drug_information": { "unit": 4.50, "type": "GM" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "65219025905a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 264.00, "discounted_cash": 158.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 181.24, "10th_percentile": 84.15, "90th_percentile": 242.09, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 25.91, "10th_percentile": 3.72, "90th_percentile": 77.75, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 63.44, "10th_percentile": 50.74, "90th_percentile": 80.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 66.62, "10th_percentile": 63.44, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.00, "10th_percentile": 71.00, "90th_percentile": 141.99, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenergan 25 mg 1ml inj", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "J2550", "type": "HCPCS" }, { "code": "00641092821", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.09, "10th_percentile": 2.05, "90th_percentile": 6.14, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2.89, "10th_percentile": 2.09, "90th_percentile": 3.40, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pitocin 10u 1ml amp", "drug_information": { "unit": 10.00, "type": "UN" }, "code_information": [ { "code": "J2590", "type": "HCPCS" }, { "code": "42023011625a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procainamide 1 gm/10 ml", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J2690", "type": "HCPCS" }, { "code": "14789090002a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5760.00, "discounted_cash": 3456.00, "minimum": 281.50, "maximum": 825.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 825.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 825.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 281.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procainamide 1gm 10ml vial", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J2690", "type": "HCPCS" }, { "code": "00409190211", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1010.00, "discounted_cash": 606.00, "minimum": 281.50, "maximum": 825.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 825.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 825.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 281.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxacillin 2gm vial", "drug_information": { "unit": 2.00, "type": "GM" }, "code_information": [ { "code": "J2700", "type": "HCPCS" }, { "code": "64679069901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 278.00, "discounted_cash": 166.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diprivan 10mg/ml 20ml", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J2704", "type": "HCPCS" }, { "code": "63323026929b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.52, "10th_percentile": 7.52, "90th_percentile": 80.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 2.62, "10th_percentile": 2.62, "90th_percentile": 5.23, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 5.90, "10th_percentile": 5.16, "90th_percentile": 52.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 16.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diprivan 1000mg 100ml", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J2704", "type": "HCPCS" }, { "code": "00409469924", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 207.00, "discounted_cash": 124.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 7.52, "10th_percentile": 7.52, "90th_percentile": 80.11, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 2.62, "10th_percentile": 2.62, "90th_percentile": 5.23, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "13", "median_amount": 5.90, "10th_percentile": 5.16, "90th_percentile": 52.44, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "28", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 16.49, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bloxiverz 10 mg / 10 ml vial", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J2710", "type": "HCPCS" }, { "code": "00548960200a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 103.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protamin sulf 250mg/25ml", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J2720", "type": "HCPCS" }, { "code": "63323022930", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 579.00, "discounted_cash": 347.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protopam 1 gm inj", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J2730", "type": "HCPCS" }, { "code": "60977014101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 832.00, "discounted_cash": 499.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phentolamine 5 mg injection", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "J2760", "type": "HCPCS" }, { "code": "00143956401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4704.00, "discounted_cash": 2822.40, "minimum": 444.81, "maximum": 1304.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1304.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1304.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 444.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reglan 10 mg/2ml inj", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J2765", "type": "HCPCS" }, { "code": "23155024031a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 7.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 0.59, "10th_percentile": 0.59, "90th_percentile": 0.59, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lexiscan 0.4 / 5 ml syringe", "drug_information": { "unit": 0.40, "type": "ME" }, "code_information": [ { "code": "J2785", "type": "HCPCS" }, { "code": "00469650189", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2523.00, "discounted_cash": 1513.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 613.31, "10th_percentile": 613.31, "90th_percentile": 613.31, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rho d immune globulin inj", "code_information": [ { "code": "J2790", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 574.25, "discounted_cash": 344.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rhogam", "code_information": [ { "code": "J2790", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 574.25, "discounted_cash": 344.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ropivacaine hcl injection", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J2795", "type": "HCPCS" }, { "code": "63323028620", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 83.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trimethoprim sulfa 16ml 10ml", "drug_information": { "unit": 160.00, "type": "ME" }, "code_information": [ { "code": "J2865", "type": "HCPCS" }, { "code": "70069036210a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 87.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferrlecit 62.5mg/5ml inj", "drug_information": { "unit": 62.50, "type": "ME" }, "code_information": [ { "code": "J2916", "type": "HCPCS" }, { "code": "00024279210", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 366.00, "discounted_cash": 219.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 133.56, "10th_percentile": 89.04, "90th_percentile": 1273.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Solu medrol 1000 mg inj", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009069801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 422.00, "discounted_cash": 253.20, "minimum": 0.25, "maximum": 0.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.51, "10th_percentile": 6.51, "90th_percentile": 28.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.73, "count": "1 through 10", "median_amount": 35.31, "10th_percentile": 21.20, "90th_percentile": 69.81, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 4.53, "10th_percentile": 2.06, "90th_percentile": 19.30, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.25, "count": "1 through 10", "median_amount": 12.89, "10th_percentile": 6.12, "90th_percentile": 28.62, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 28.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.37, "10th_percentile": 24.66, "90th_percentile": 26.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprdnisolon sod succn40mg", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009003930A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "minimum": 0.25, "maximum": 0.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.51, "10th_percentile": 6.51, "90th_percentile": 28.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.73, "count": "1 through 10", "median_amount": 35.31, "10th_percentile": 21.20, "90th_percentile": 69.81, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 4.53, "10th_percentile": 2.06, "90th_percentile": 19.30, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.25, "count": "1 through 10", "median_amount": 12.89, "10th_percentile": 6.12, "90th_percentile": 28.62, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 28.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.37, "10th_percentile": 24.66, "90th_percentile": 26.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Solu medrol 125 mg inj", "drug_information": { "unit": 125.00, "type": "ME" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009004725a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 55.80, "minimum": 0.25, "maximum": 0.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.51, "10th_percentile": 6.51, "90th_percentile": 28.91, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.73, "count": "1 through 10", "median_amount": 35.31, "10th_percentile": 21.20, "90th_percentile": 69.81, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 4.53, "10th_percentile": 2.06, "90th_percentile": 19.30, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.25, "count": "1 through 10", "median_amount": 12.89, "10th_percentile": 6.12, "90th_percentile": 28.62, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "18", "median_amount": 6.38, "10th_percentile": 6.38, "90th_percentile": 28.34, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.37, "10th_percentile": 24.66, "90th_percentile": 26.08, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cathflo 2mg (inj)", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J2997", "type": "HCPCS" }, { "code": "50242004164", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1867.00, "discounted_cash": 1120.20, "minimum": 90.55, "maximum": 265.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 265.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 265.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 174.22, "10th_percentile": 174.22, "90th_percentile": 174.22, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 90.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vyepti 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J3032", "type": "HCPCS" }, { "code": "67386013051", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5303.00, "discounted_cash": 3181.80, "minimum": 19.13, "maximum": 56.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 56.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 56.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tenectaplase tnkase 50 mg kit", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J3101", "type": "HCPCS" }, { "code": "50242012047a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20921.00, "discounted_cash": 12552.60, "minimum": 160.84, "maximum": 471.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4501.27, "10th_percentile": 2340.66, "90th_percentile": 6661.89, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 471.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 471.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 160.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3455.82, "10th_percentile": 3169.49, "90th_percentile": 3643.44, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brethine 1mg/1ml inj", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J3105", "type": "HCPCS" }, { "code": "63323066501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 189.00, "discounted_cash": 113.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thorazine 50mg/2ml inj", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "J3230", "type": "HCPCS" }, { "code": "00641139735", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 79.00, "discounted_cash": 47.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tigecycline 50 mg vial", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J3243", "type": "HCPCS" }, { "code": "70121164701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1502.00, "discounted_cash": 901.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nebcin 80 mg / 2 ml inj", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "J3260", "type": "HCPCS" }, { "code": "00409357801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 17.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kenalog 40 mg/ml injection", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J3301", "type": "HCPCS" }, { "code": "00003029305A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 90.00, "discounted_cash": 54.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.65, "10th_percentile": 20.65, "90th_percentile": 20.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.35, "10th_percentile": 27.35, "90th_percentile": 27.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.48, "10th_percentile": 20.75, "90th_percentile": 24.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kenalog 10 susp(50mg/5ml vial)", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J3301", "type": "HCPCS" }, { "code": "00003049420", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 116.00, "discounted_cash": 69.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.65, "10th_percentile": 20.65, "90th_percentile": 20.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.35, "10th_percentile": 27.35, "90th_percentile": 27.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.48, "10th_percentile": 20.75, "90th_percentile": 24.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triamcinolone 200mg/5ml mdv", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J3301", "type": "HCPCS" }, { "code": "70121116801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 299.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.65, "10th_percentile": 20.65, "90th_percentile": 20.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 27.35, "10th_percentile": 27.35, "90th_percentile": 27.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.48, "10th_percentile": 20.75, "90th_percentile": 24.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zilretta 32 mg inj", "drug_information": { "unit": 32.00, "type": "ME" }, "code_information": [ { "code": "J3304", "type": "HCPCS" }, { "code": "65250000301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2359.00, "discounted_cash": 1415.40, "minimum": 17.83, "maximum": 52.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 52.28, "count": "1 through 10", "median_amount": 2429.46, "10th_percentile": 2429.46, "90th_percentile": 2429.46, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 52.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 751.90, "10th_percentile": 751.90, "90th_percentile": 751.90, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 142.03, "10th_percentile": 63.23, "90th_percentile": 220.84, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 17.83, "count": "1 through 10", "median_amount": 590.78, "10th_percentile": 590.78, "90th_percentile": 590.78, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 596.55, "10th_percentile": 596.55, "90th_percentile": 596.55, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1808.86, "10th_percentile": 1808.86, "90th_percentile": 1808.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1808.86, "10th_percentile": 1808.86, "90th_percentile": 1808.87, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 667.62, "10th_percentile": 260.07, "90th_percentile": 750.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Valium 10mg/2ml inj", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J3360", "type": "HCPCS" }, { "code": "00409127332", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 315.00, "discounted_cash": 189.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 16.99, "10th_percentile": 8.50, "90th_percentile": 29.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 47.89, "10th_percentile": 47.88, "90th_percentile": 47.89, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 71.84, "10th_percentile": 23.95, "90th_percentile": 84.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin 500mg", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J3373", "type": "HCPCS" }, { "code": "00409433201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 46.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.34, "10th_percentile": 13.80, "90th_percentile": 31.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 21.67, "10th_percentile": 3.53, "90th_percentile": 23.84, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.20, "10th_percentile": 16.15, "90th_percentile": 80.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin hcl inj 1g/200ml", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J3373", "type": "HCPCS" }, { "code": "70594004201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 221.00, "discounted_cash": 132.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.34, "10th_percentile": 13.80, "90th_percentile": 31.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 21.67, "10th_percentile": 3.53, "90th_percentile": 23.84, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.20, "10th_percentile": 16.15, "90th_percentile": 80.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin 1000 mg", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J3373", "type": "HCPCS" }, { "code": "70860010520a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 72.00, "discounted_cash": 43.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.34, "10th_percentile": 13.80, "90th_percentile": 31.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 21.67, "10th_percentile": 3.53, "90th_percentile": 23.84, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.20, "10th_percentile": 16.15, "90th_percentile": 80.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin 750mg vial", "drug_information": { "unit": 750.00, "type": "ME" }, "code_information": [ { "code": "J3373", "type": "HCPCS" }, { "code": "71288002421", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 86.00, "discounted_cash": 51.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.34, "10th_percentile": 13.80, "90th_percentile": 31.65, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 21.67, "10th_percentile": 3.53, "90th_percentile": 23.84, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 67.20, "10th_percentile": 16.15, "90th_percentile": 80.64, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin 750mg/150ml premix", "drug_information": { "unit": 750.00, "type": "ME" }, "code_information": [ { "code": "J3375", "type": "HCPCS" }, { "code": "70594005601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 82.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.90, "10th_percentile": 14.90, "90th_percentile": 14.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin hcl ij 1500mg/300ml", "drug_information": { "unit": 1.50, "type": "GM" }, "code_information": [ { "code": "J3375", "type": "HCPCS" }, { "code": "00143946901a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 265.00, "discounted_cash": 159.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.90, "10th_percentile": 14.90, "90th_percentile": 14.90, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vedolizumab 300 mg iv", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "J3380", "type": "HCPCS" }, { "code": "64764030020A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30326.00, "discounted_cash": 18195.60, "minimum": 20.95, "maximum": 61.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 61.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 61.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 20.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vistaril 100mg 2ml inj", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J3410", "type": "HCPCS" }, { "code": "00517560125", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 324.00, "discounted_cash": 194.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thiamine 200 mg/2ml", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J3411", "type": "HCPCS" }, { "code": "63323001302", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 28.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aqmephyt 10mg 1ml inj", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J3430", "type": "HCPCS" }, { "code": "00409915801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 470.00, "discounted_cash": 282.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aqmephyt 1mg 0.5ml inj", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J3430", "type": "HCPCS" }, { "code": "76329124001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 142.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hylenex 150 un", "drug_information": { "unit": 150.00, "type": "UN" }, "code_information": [ { "code": "J3473", "type": "HCPCS" }, { "code": "18657011704", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 536.00, "discounted_cash": 321.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium sulf 2gm n/wat inj", "drug_information": { "unit": 2.00, "type": "GM" }, "code_information": [ { "code": "J3475", "type": "HCPCS" }, { "code": "44567042024a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 45.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.73, "10th_percentile": 11.72, "90th_percentile": 23.45, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.15, "10th_percentile": 8.15, "90th_percentile": 13.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.77, "10th_percentile": 21.93, "90th_percentile": 36.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.84, "10th_percentile": 22.99, "90th_percentile": 39.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.01, "10th_percentile": 6.95, "90th_percentile": 19.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mag sulfate 1 gm / 2 ml", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J3475", "type": "HCPCS" }, { "code": "63323006402A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.73, "10th_percentile": 11.72, "90th_percentile": 23.45, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.15, "10th_percentile": 8.15, "90th_percentile": 13.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.77, "10th_percentile": 21.93, "90th_percentile": 36.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.84, "10th_percentile": 22.99, "90th_percentile": 39.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.01, "10th_percentile": 6.95, "90th_percentile": 19.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium sulfate 40 gm premix", "drug_information": { "unit": 40000.00, "type": "ME" }, "code_information": [ { "code": "J3475", "type": "HCPCS" }, { "code": "63323010610a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 81.00, "discounted_cash": 48.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.73, "10th_percentile": 11.72, "90th_percentile": 23.45, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.15, "10th_percentile": 8.15, "90th_percentile": 13.05, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 36.77, "10th_percentile": 21.93, "90th_percentile": 36.77, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 23.84, "10th_percentile": 22.99, "90th_percentile": 39.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.01, "10th_percentile": 6.95, "90th_percentile": 19.07, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kcl 40 meq premixed ns 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J3480", "type": "HCPCS" }, { "code": "00338069504a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 4.10, "10th_percentile": 3.72, "90th_percentile": 11.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 11.53, "10th_percentile": 11.53, "90th_percentile": 34.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kcl 20 meg premixed ns 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J3480", "type": "HCPCS" }, { "code": "00264786500a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 52.00, "discounted_cash": 31.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 4.10, "10th_percentile": 3.72, "90th_percentile": 11.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 11.53, "10th_percentile": 11.53, "90th_percentile": 34.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kcl 20 meq prmxd ds 45 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J3480", "type": "HCPCS" }, { "code": "00264763500a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 28.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 4.10, "10th_percentile": 3.72, "90th_percentile": 11.15, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 11.53, "10th_percentile": 11.53, "90th_percentile": 34.94, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Geodon 20mg inj", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J3486", "type": "HCPCS" }, { "code": "43598006158a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 191.00, "discounted_cash": 114.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.38, "10th_percentile": 9.37, "90th_percentile": 10.31, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 29.05, "10th_percentile": 29.05, "90th_percentile": 29.06, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zometa 4mg/100ml", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "J3489", "type": "HCPCS" }, { "code": "25021080166A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1728.00, "discounted_cash": 1036.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1338.37, "10th_percentile": 1338.37, "90th_percentile": 1338.37, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 581.76, "10th_percentile": 581.76, "90th_percentile": 581.76, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1311.60, "10th_percentile": 1311.60, "90th_percentile": 1311.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1147.65, "10th_percentile": 1147.65, "90th_percentile": 1246.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1467.89, "10th_percentile": 1467.89, "90th_percentile": 1467.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reclast 5mg/100ml", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "J3489", "type": "HCPCS" }, { "code": "67457079410A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5397.00, "discounted_cash": 3238.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1338.37, "10th_percentile": 1338.37, "90th_percentile": 1338.37, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 581.76, "10th_percentile": 581.76, "90th_percentile": 581.76, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1311.60, "10th_percentile": 1311.60, "90th_percentile": 1311.60, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1147.65, "10th_percentile": 1147.65, "90th_percentile": 1246.03, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1467.89, "10th_percentile": 1467.89, "90th_percentile": 1467.89, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin 1.25g vial", "drug_information": { "unit": 1.25, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "67457082312", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 232.00, "discounted_cash": 139.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Norcuron inj", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "67457043800A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 4mg/ml 5ml vial", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323016503", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 36.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarbonate 4.2 % 5 ml", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323002605", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vibramycin 100 mg inj", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323013011A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 232.00, "discounted_cash": 139.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Folvite 5mg/10ml inj", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323018410", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levothyroxine 100 mcg / 5 ml", "drug_information": { "unit": 0.10, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323064907", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1155.00, "discounted_cash": 693.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine with epinephrine", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323048201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 22.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zemuron 10mg/5ml inj", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323042602a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 20.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bupivacaine hci epi 0.5%", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323046301", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 99.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefotetan 1 gm vial", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323038510A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 139.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefotetan 2 gm vial", "drug_information": { "unit": 2.00, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323038620", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 530.00, "discounted_cash": 318.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aztrfeonam 1000mg vial iv/im", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323040120A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 285.00, "discounted_cash": 171.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Famotidine 20 mg inj", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323073911a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium chloride 10% syr 10ml", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "64253090030A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 98.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyanokit 5 gm vial", "drug_information": { "unit": 5.00, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "50633031011a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2846.00, "discounted_cash": 1707.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bupivacine 0.25% 10 ml vial", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "55150016710A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 18.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brevibloc 10mg inj", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "55150019410a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 50.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calan 5mg/2ml inj", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "51754020302a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mvi conc 5 ml", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "54643564901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 88.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trifluridine 1% eye sol btl", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "61314004475", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 314.00, "discounted_cash": 188.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyclogyl 1% eye solution", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "61314039601a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 81.00, "discounted_cash": 48.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketamine 200mg/20ml vial", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "55150043801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 232.00, "discounted_cash": 139.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metronidazole 500 mg rtu", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "25021013182a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ofloxacin 0.3% eye solution", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "24208043410a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 55.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dantrium 20mg vial", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "42023012306", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 851.00, "discounted_cash": 510.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol tartrate 5mg/5ml", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "36000003310A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pitressin 20 units/ml", "drug_information": { "unit": 20.00, "type": "UN" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "42023016425A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 95.00, "discounted_cash": 57.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tobramycin 0.3% eye solution", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "24208029005a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3.00, "discounted_cash": 1.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Proparacaine 0.5% opthal sol", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "24208073006a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 13.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ephedrine sulf 50mg/ml inj", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00641623801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 105.00, "discounted_cash": 63.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% 5ml syr", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "08290306546", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicardipine 20mg/200ml premix", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "10122031301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 836.00, "discounted_cash": 501.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine 1% 50ml multidose vl", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409427617", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 16.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Etomidate 40 mg/20 ml inj", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409669502", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 71.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hespan 500 ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409724803", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 608.00, "discounted_cash": 364.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardizem 100mg adv vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409435013a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 66.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sterile water for inj 10 ml", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409488710", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% 10ml", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409488810", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarb 4.2% 10ml", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409553424a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 212.00, "discounted_cash": 127.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Robinol 2 ml inj", "drug_information": { "unit": 0.40, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00517460225", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Racepinephrine (s-2) inhalant", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00487590199", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardizem 25 mg injection", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00641601301a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 11.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dopram 20 mg 1ml inj", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00641601801a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 511.00, "discounted_cash": 306.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acidose sorbitol 50 gm 240ml", "drug_information": { "unit": 50.00, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00574052176a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 227.00, "discounted_cash": 136.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mannitol 20% solution 500ml iv", "drug_information": { "unit": 100.00, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00990771503a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 183.00, "discounted_cash": 109.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% 150ml bag", "drug_information": { "unit": 150.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00990798361A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.00, "discounted_cash": 31.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 5% naci 0.2% 500ml bg", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00264761610A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Liposyn ii 20% 500ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00264446010a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 227.00, "discounted_cash": 136.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketamine 500mg/10ml vial inj", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143950810A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 90.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketamine 500mg/5ml", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143950910", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mazicon romazicon 0.1 mg 1ml", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143978410A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 895.00, "discounted_cash": 537.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Valproate 500mg/5ml vial", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143978510", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 67.00, "discounted_cash": 40.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vasotec 2.5mg/2ml", "drug_information": { "unit": 2.50, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143978610", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 54.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kcl 20meq in d5w/0.9% nacl1000", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00338080304a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 102.00, "discounted_cash": 61.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sensorcaine 0.25% mpf 30ml (e)", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409115902", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bupivacaine 0.5% 50ml inj", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409116202A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bupivicaine 0.75% 10 ml vial", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409158210", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Marcaine 0.5% epinephrine", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409174929", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 131.00, "discounted_cash": 78.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Marcaine spinal 0.75% ampule", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409176118", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 34.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aminosyn 5%dextrose 20% 1000ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00338113803", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 258.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Famotidine 20mg premixed 50ml", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00338519741", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 37.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clindamycin 600mg 50ml", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00338954950", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 61.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bacteriostatic water inj", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409397703", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Norepinephrine 4mg/4ml inject", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409337504A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 141.00, "discounted_cash": 84.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Labetalol 20mg/4ml carpuject", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409233924a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Normodyne inj", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143932001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 17.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyklokapron 1000 mg/10ml vial", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00013111420A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 484.00, "discounted_cash": 290.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trulicity 4.5mg/0.5ml pen", "drug_information": { "unit": 4.50, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00002318280", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2417.00, "discounted_cash": 1450.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trulicity pen injector 0.75mg", "drug_information": { "unit": 0.75, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00002143380A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2417.00, "discounted_cash": 1450.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bridion 100mg/ml", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00006542312", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1372.00, "discounted_cash": 823.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sugmmadex 500mg/5ml vial", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00006542515", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2513.00, "discounted_cash": 1507.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tetracaine 0.5% eye solution", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00065074114A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xylocaine syr 100mg/5ml", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "76329339001a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarb sy 8.4% 50ml", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "76329335201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 124.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin hcl ij 1250mg/250ml", "drug_information": { "unit": 1.25, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "70594005701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 219.00, "discounted_cash": 131.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin hcl ij 2000mg/400ml", "drug_information": { "unit": 2.00, "type": "GM" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "70594004401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 323.00, "discounted_cash": 193.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 125mg/25ml vial", "drug_information": { "unit": 125.00, "type": "ME" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "70860030125a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenylephrine 2.5% eye sol", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "70756062925a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 195.00, "discounted_cash": 117.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Flurbiprofen 0.03% eye sol", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "69292072225b", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 99.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Visionblue 0.06% eye solution", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "68803061210", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 267.00, "discounted_cash": 160.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "1 through 10", "median_amount": 2.48, "10th_percentile": 2.48, "90th_percentile": 2.48, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "88", "median_amount": 17.13, "10th_percentile": 6.38, "90th_percentile": 71.90, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "334", "median_amount": 5.96, "10th_percentile": 1.40, "90th_percentile": 22.73, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 24.96, "10th_percentile": 6.98, "90th_percentile": 63.79, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "254", "median_amount": 17.13, "10th_percentile": 5.48, "90th_percentile": 66.54, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 23.34, "10th_percentile": 14.14, "90th_percentile": 60.69, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "99", "median_amount": 21.90, "10th_percentile": 5.94, "90th_percentile": 60.83, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dupilumab 300mg/2ml syringe", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "J3590", "type": "HCPCS" }, { "code": "00024591401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6216.00, "discounted_cash": 3729.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1337.58, "10th_percentile": 1337.58, "90th_percentile": 1337.58, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Normal saline 0.9% 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J7030", "type": "HCPCS" }, { "code": "00264780000", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "19", "median_amount": 8.13, "10th_percentile": 6.50, "90th_percentile": 9.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 20.55, "10th_percentile": 20.55, "90th_percentile": 20.55, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "15", "median_amount": 6.37, "10th_percentile": 6.37, "90th_percentile": 7.97, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "128", "median_amount": 7.97, "10th_percentile": 7.97, "90th_percentile": 7.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.14, "10th_percentile": 24.14, "90th_percentile": 24.14, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.14, "10th_percentile": 24.14, "90th_percentile": 24.14, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 8.03, "10th_percentile": 7.14, "90th_percentile": 8.92, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.14, "10th_percentile": 24.14, "90th_percentile": 24.15, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.14, "10th_percentile": 24.14, "90th_percentile": 24.15, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Normal saline 0.9% 500 ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7040", "type": "HCPCS" }, { "code": "00264780010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 19.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.05, "10th_percentile": 6.43, "90th_percentile": 19.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.44, "10th_percentile": 25.44, "90th_percentile": 25.44, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.11, "10th_percentile": 12.87, "90th_percentile": 35.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 9.86, "10th_percentile": 7.88, "90th_percentile": 9.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 167.39, "10th_percentile": 167.39, "90th_percentile": 167.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 167.39, "10th_percentile": 167.39, "90th_percentile": 167.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.22, "10th_percentile": 24.22, "90th_percentile": 24.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.22, "10th_percentile": 24.22, "90th_percentile": 24.22, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Normal saline 0.9% 50 ml", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J7040", "type": "HCPCS" }, { "code": "00264180031", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 15.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 9.05, "10th_percentile": 6.43, "90th_percentile": 19.29, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 25.44, "10th_percentile": 25.44, "90th_percentile": 25.44, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 24.11, "10th_percentile": 12.87, "90th_percentile": 35.35, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 9.86, "10th_percentile": 7.88, "90th_percentile": 9.86, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 167.39, "10th_percentile": 167.39, "90th_percentile": 167.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 167.39, "10th_percentile": 167.39, "90th_percentile": 167.39, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.22, "10th_percentile": 24.22, "90th_percentile": 24.22, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 24.22, "10th_percentile": 24.22, "90th_percentile": 24.22, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dextrose 5% nacl 0.9% 1000ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J7042", "type": "HCPCS" }, { "code": "00264761000", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.54, "10th_percentile": 9.02, "90th_percentile": 92.18, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 5% nacl 0.45% 500 ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7042", "type": "HCPCS" }, { "code": "00338008503A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.54, "10th_percentile": 9.02, "90th_percentile": 92.18, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Normal saline 0.9% 250 ml", "drug_information": { "unit": 250.00, "type": "ML" }, "code_information": [ { "code": "J7050", "type": "HCPCS" }, { "code": "00264780020", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.10, "10th_percentile": 6.26, "90th_percentile": 14.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.71, "10th_percentile": 11.14, "90th_percentile": 37.88, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 3.46, "10th_percentile": 3.46, "90th_percentile": 5.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 4.33, "10th_percentile": 2.48, "90th_percentile": 6.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.36, "10th_percentile": 1.51, "90th_percentile": 12.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Normal saline 100 ml", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J7050", "type": "HCPCS" }, { "code": "00264180032", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 8.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.10, "10th_percentile": 6.26, "90th_percentile": 14.10, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16.71, "10th_percentile": 11.14, "90th_percentile": 37.88, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "24", "median_amount": 3.46, "10th_percentile": 3.46, "90th_percentile": 5.59, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "90", "median_amount": 4.33, "10th_percentile": 2.48, "90th_percentile": 6.35, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4.36, "10th_percentile": 1.51, "90th_percentile": 12.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 5% 500ml excel bag", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7060", "type": "HCPCS" }, { "code": "00264751010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 23.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.42, "10th_percentile": 13.42, "90th_percentile": 13.42, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.63, "10th_percentile": 30.63, "90th_percentile": 30.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.52, "10th_percentile": 10.50, "90th_percentile": 10.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.87, "10th_percentile": 7.21, "90th_percentile": 13.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5w 250 ml", "drug_information": { "unit": 250.00, "type": "ML" }, "code_information": [ { "code": "J7060", "type": "HCPCS" }, { "code": "00264751020a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 25.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.42, "10th_percentile": 13.42, "90th_percentile": 13.42, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.63, "10th_percentile": 30.63, "90th_percentile": 30.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.52, "10th_percentile": 10.50, "90th_percentile": 10.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.87, "10th_percentile": 7.21, "90th_percentile": 13.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D10w 500ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7060", "type": "HCPCS" }, { "code": "00264752010", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.42, "10th_percentile": 13.42, "90th_percentile": 13.42, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.63, "10th_percentile": 30.63, "90th_percentile": 30.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.52, "10th_percentile": 10.50, "90th_percentile": 10.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.87, "10th_percentile": 7.21, "90th_percentile": 13.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5w 50 ml", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J7060", "type": "HCPCS" }, { "code": "00264151031a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 14.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.42, "10th_percentile": 13.42, "90th_percentile": 13.42, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.63, "10th_percentile": 30.63, "90th_percentile": 30.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.52, "10th_percentile": 10.50, "90th_percentile": 10.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.87, "10th_percentile": 7.21, "90th_percentile": 13.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5w 100 ml", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J7060", "type": "HCPCS" }, { "code": "00264151032", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.42, "10th_percentile": 13.42, "90th_percentile": 13.42, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.63, "10th_percentile": 30.63, "90th_percentile": 30.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.52, "10th_percentile": 10.50, "90th_percentile": 10.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.87, "10th_percentile": 7.21, "90th_percentile": 13.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Advantage d5w 100ml", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J7060", "type": "HCPCS" }, { "code": "00409710067", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 23.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.42, "10th_percentile": 13.42, "90th_percentile": 13.42, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.63, "10th_percentile": 30.63, "90th_percentile": 30.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.52, "10th_percentile": 10.50, "90th_percentile": 10.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.87, "10th_percentile": 7.21, "90th_percentile": 13.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5w 500 ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7060", "type": "HCPCS" }, { "code": "65219046020a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 25.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13.42, "10th_percentile": 13.42, "90th_percentile": 13.42, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 30.63, "10th_percentile": 30.63, "90th_percentile": 30.63, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 10.52, "10th_percentile": 10.50, "90th_percentile": 10.53, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.87, "10th_percentile": 7.21, "90th_percentile": 13.24, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5w 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J7070", "type": "HCPCS" }, { "code": "00264751000", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 23.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 11.73, "10th_percentile": 11.73, "90th_percentile": 11.73, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lactated ringers 1000 ml", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "J7120", "type": "HCPCS" }, { "code": "00264775000", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 63.00, "discounted_cash": 37.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 19.40, "10th_percentile": 15.52, "90th_percentile": 20.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.21, "10th_percentile": 14.96, "90th_percentile": 38.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "96", "median_amount": 19.02, "10th_percentile": 18.12, "90th_percentile": 19.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 57.66, "90th_percentile": 57.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 57.66, "90th_percentile": 57.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 21.29, "10th_percentile": 17.03, "90th_percentile": 21.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 56.17, "90th_percentile": 58.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 56.17, "90th_percentile": 58.48, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lactated ringer's 500ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7120", "type": "HCPCS" }, { "code": "00338011703A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 26.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 19.40, "10th_percentile": 15.52, "90th_percentile": 20.57, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.21, "10th_percentile": 14.96, "90th_percentile": 38.28, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "96", "median_amount": 19.02, "10th_percentile": 18.12, "90th_percentile": 19.02, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 57.66, "90th_percentile": 57.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 57.66, "90th_percentile": 57.66, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "21", "median_amount": 21.29, "10th_percentile": 17.03, "90th_percentile": 21.29, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 56.17, "90th_percentile": 58.48, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 57.66, "10th_percentile": 56.17, "90th_percentile": 58.48, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sodium chloride 234mg/ml con", "drug_information": { "unit": 234.00, "type": "ME" }, "code_information": [ { "code": "J7131", "type": "HCPCS" }, { "code": "63323009330A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prothrombin complex kcentra", "drug_information": { "unit": 1000.00, "type": "UN" }, "code_information": [ { "code": "J7168", "type": "HCPCS" }, { "code": "63833038702A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7155.00, "discounted_cash": 4293.00, "minimum": 2.16, "maximum": 6.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 6.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 6.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 2.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Goserelin acetate 3.6mg", "drug_information": { "unit": 3.60, "type": "ME" }, "code_information": [ { "code": "J7307", "type": "HCPCS" }, { "code": "70720095036", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2899.00, "discounted_cash": 1739.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nexplanon implant", "drug_information": { "unit": 68.00, "type": "ME" }, "code_information": [ { "code": "J7307", "type": "HCPCS" }, { "code": "78206014501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12243.00, "discounted_cash": 7345.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levulan kerastick 20% top sol", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7308", "type": "HCPCS" }, { "code": "67308010101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3775.00, "discounted_cash": 2265.00, "minimum": 390.47, "maximum": 1144.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1144.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1144.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 390.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pilocarpine 4% opthalmic sol", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7315", "type": "HCPCS" }, { "code": "70069020101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 64.00, "discounted_cash": 38.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 19.76, "methodology": "percent of total billed charges" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 19.76, "10th_percentile": 19.44, "90th_percentile": 19.76, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "16", "median_amount": 15.50, "10th_percentile": 13.56, "90th_percentile": 19.37, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 17.34, "10th_percentile": 17.34, "90th_percentile": 17.34, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dujralane 60mg inj", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "J7318", "type": "HCPCS" }, { "code": "89130202001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10704.00, "discounted_cash": 6422.40, "minimum": 6.86, "maximum": 20.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 20.12, "count": "1 through 10", "median_amount": 2156.36, "10th_percentile": 2156.36, "90th_percentile": 2156.36, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 20.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6.86, "count": "1 through 10", "median_amount": 2628.05, "10th_percentile": 2628.05, "90th_percentile": 2628.05, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3137.37, "10th_percentile": 3137.37, "90th_percentile": 3137.37, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2601.50, "10th_percentile": 2601.50, "90th_percentile": 2601.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Durolane 60mg/3ml syr", "drug_information": { "unit": 60.00, "type": "ME" }, "code_information": [ { "code": "J7318", "type": "HCPCS" }, { "code": "16986002080", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3863.00, "discounted_cash": 2317.80, "minimum": 6.86, "maximum": 20.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 20.12, "count": "1 through 10", "median_amount": 2156.36, "10th_percentile": 2156.36, "90th_percentile": 2156.36, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 20.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6.86, "count": "1 through 10", "median_amount": 2628.05, "10th_percentile": 2628.05, "90th_percentile": 2628.05, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3137.37, "10th_percentile": 3137.37, "90th_percentile": 3137.37, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2601.50, "10th_percentile": 2601.50, "90th_percentile": 2601.50, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Supartz fx 2 mg/2.5ml syringe", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J7321", "type": "HCPCS" }, { "code": "89130444401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 822.00, "discounted_cash": 493.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hyalgan 10mg/ml syringe 2 ml", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J7321", "type": "HCPCS" }, { "code": "89122072420A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1824.00, "discounted_cash": 1094.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hymovis one 32mg/4ml syringe", "drug_information": { "unit": 32.00, "type": "ME" }, "code_information": [ { "code": "J7322", "type": "HCPCS" }, { "code": "89122075001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2311.00, "discounted_cash": 1386.60, "minimum": 17.33, "maximum": 50.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 50.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 50.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 17.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Euflexxa inj per dose", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J7323", "type": "HCPCS" }, { "code": "55566410001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1262.00, "discounted_cash": 757.20, "minimum": 127.42, "maximum": 373.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 373.59, "count": "12", "median_amount": 797.09, "10th_percentile": 607.84, "90th_percentile": 1037.67, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 373.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "12", "median_amount": 129.89, "10th_percentile": 123.71, "90th_percentile": 136.07, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 127.42, "count": "1 through 10", "median_amount": 309.90, "10th_percentile": 309.90, "90th_percentile": 309.90, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 313.04, "10th_percentile": 313.04, "90th_percentile": 313.04, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "32", "median_amount": 343.34, "10th_percentile": 216.20, "90th_percentile": 429.17, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1162.78, "10th_percentile": 735.52, "90th_percentile": 1162.78, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1162.78, "10th_percentile": 735.52, "90th_percentile": 1162.78, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Orthovisc 30 mg / 2 ml syringe", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J7324", "type": "HCPCS" }, { "code": "59676036001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 445.00, "discounted_cash": 267.00, "minimum": 124.05, "maximum": 363.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 363.70, "count": "13", "median_amount": 1196.47, "10th_percentile": 1126.09, "90th_percentile": 1325.33, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 363.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 609.95, "10th_percentile": 242.44, "90th_percentile": 768.96, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "51", "median_amount": 163.95, "10th_percentile": 163.95, "90th_percentile": 180.35, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 124.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 414.90, "10th_percentile": 414.90, "90th_percentile": 416.25, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 275.36, "10th_percentile": 202.86, "90th_percentile": 339.70, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Synvisc 16mg injection", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J7325", "type": "HCPCS" }, { "code": "58468009001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4383.00, "discounted_cash": 2629.80, "minimum": 9.16, "maximum": 26.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 26.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 26.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 9.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1398.09, "10th_percentile": 1386.86, "90th_percentile": 1398.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 174.70, "10th_percentile": 174.70, "90th_percentile": 174.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Synvisc one 1 mg", "drug_information": { "unit": 48.00, "type": "ME" }, "code_information": [ { "code": "J7325", "type": "HCPCS" }, { "code": "58468009003", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4794.00, "discounted_cash": 2876.40, "minimum": 9.16, "maximum": 26.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 26.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 26.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 9.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1398.09, "10th_percentile": 1386.86, "90th_percentile": 1398.09, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 174.70, "10th_percentile": 174.70, "90th_percentile": 174.70, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gel one 30mg/3ml syringe", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J7326", "type": "HCPCS" }, { "code": "50016095711A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3812.00, "discounted_cash": 2287.20, "minimum": 533.10, "maximum": 1562.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1562.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1562.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 533.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Qutenza 8% topical sys (2pk)", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7336", "type": "HCPCS" }, { "code": "72512092901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5951.00, "discounted_cash": 3570.60, "minimum": 3.35, "maximum": 9.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3.35, "count": "1 through 10", "median_amount": 3122.58, "10th_percentile": 3122.58, "90th_percentile": 3122.58, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Qutenza 8% topical sys (4pk)", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7336", "type": "HCPCS" }, { "code": "72512093001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12382.00, "discounted_cash": 7429.20, "minimum": 3.35, "maximum": 9.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 9.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 9.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3.35, "count": "1 through 10", "median_amount": 3122.58, "10th_percentile": 3122.58, "90th_percentile": 3122.58, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tacrolimus 0.5mg", "drug_information": { "unit": 0.50, "type": "ME" }, "code_information": [ { "code": "J7507", "type": "HCPCS" }, { "code": "68084044911a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycophenolate mofetil 250mg ca", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J7517", "type": "HCPCS" }, { "code": "50268055715", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycophenolic acid dr 180mg", "drug_information": { "unit": 180.00, "type": "ME" }, "code_information": [ { "code": "J7518", "type": "HCPCS" }, { "code": "00078038566", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 73.00, "discounted_cash": 43.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tobramycin 300mg/5ml neb", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "J7682", "type": "HCPCS" }, { "code": "65162091446", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1357.00, "discounted_cash": 814.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 10% 250 ml bag", "drug_information": { "unit": 250.00, "type": "ML" }, "code_information": [ { "code": "J7799", "type": "HCPCS" }, { "code": "00338002302A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 36.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xeloda 500 mg oral", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J8522", "type": "HCPCS" }, { "code": "60687014911a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 225.60, "minimum": 0.07, "maximum": 0.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tarceva 100 mg oral", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J8999", "type": "HCPCS" }, { "code": "68382091406a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2726.00, "discounted_cash": 1635.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydroxyurea 500mg capsule", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J8999", "type": "HCPCS" }, { "code": "68084028411A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 7.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adriamycin 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9000", "type": "HCPCS" }, { "code": "25021020725a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 235.00, "discounted_cash": 141.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.37, "10th_percentile": 15.37, "90th_percentile": 15.37, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxil 20 mg", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J9000", "type": "HCPCS" }, { "code": "70748033901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3101.00, "discounted_cash": 1860.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 15.37, "10th_percentile": 15.37, "90th_percentile": 15.37, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tecentriaq 1200 mg", "drug_information": { "unit": 1200.00, "type": "ME" }, "code_information": [ { "code": "J9022", "type": "HCPCS" }, { "code": "50242091701A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42424.00, "discounted_cash": 25454.40, "minimum": 88.50, "maximum": 259.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 259.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 259.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4543.04, "10th_percentile": 4543.04, "90th_percentile": 4543.04, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 88.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14083.45, "10th_percentile": 14083.45, "90th_percentile": 14083.45, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14505.96, "10th_percentile": 14505.96, "90th_percentile": 14505.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tecentriaq 840 mg", "drug_information": { "unit": 840.00, "type": "ME" }, "code_information": [ { "code": "J9022", "type": "HCPCS" }, { "code": "50242091801A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26516.00, "discounted_cash": 15909.60, "minimum": 88.50, "maximum": 259.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 259.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 259.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 4543.04, "10th_percentile": 4543.04, "90th_percentile": 4543.04, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 88.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14083.45, "10th_percentile": 14083.45, "90th_percentile": 14083.45, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14505.96, "10th_percentile": 14505.96, "90th_percentile": 14505.96, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bavencio 200 mg", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J9023", "type": "HCPCS" }, { "code": "44087353501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5108.00, "discounted_cash": 3064.80, "minimum": 96.17, "maximum": 281.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 281.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 281.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 96.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Azacitidine 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9025", "type": "HCPCS" }, { "code": "72485020101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 416.00, "discounted_cash": 249.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcg 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9030", "type": "HCPCS" }, { "code": "00052060202A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1817.00, "discounted_cash": 1090.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bendeka 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9034", "type": "HCPCS" }, { "code": "63459034804", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8621.00, "discounted_cash": 5172.60, "minimum": 13.44, "maximum": 39.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 39.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 39.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 13.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bortezomib 3.5mg vial", "drug_information": { "unit": 3.50, "type": "ME" }, "code_information": [ { "code": "J9041", "type": "HCPCS" }, { "code": "43598042660", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 720.00, "discounted_cash": 432.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Brentuximab vedotin 50mg vial", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9042", "type": "HCPCS" }, { "code": "51144005001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 48800.00, "discounted_cash": 29280.00, "minimum": 246.44, "maximum": 722.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 722.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 722.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 246.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Jevtana 60 mg", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J9043", "type": "HCPCS" }, { "code": "00024582411A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53861.00, "discounted_cash": 32316.60, "minimum": 219.49, "maximum": 643.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 643.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 643.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 219.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carboplatin 150mg 5ml", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "J9045", "type": "HCPCS" }, { "code": "00703424601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 242.00, "discounted_cash": 145.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Paraplatin 600 mg", "drug_information": { "unit": 600.00, "type": "ME" }, "code_information": [ { "code": "J9045", "type": "HCPCS" }, { "code": "61703033956", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 568.00, "discounted_cash": 340.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Erbitux 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9055", "type": "HCPCS" }, { "code": "66733094823", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8151.00, "discounted_cash": 4890.60, "minimum": 76.74, "maximum": 225.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 225.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 225.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 76.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platinol 200 mg", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J9060", "type": "HCPCS" }, { "code": "63323010364", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 790.00, "discounted_cash": 474.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carboplatin 450mg 45ml", "drug_information": { "unit": 450.00, "type": "ME" }, "code_information": [ { "code": "J9060", "type": "HCPCS" }, { "code": "54288016601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 481.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cisplatin 100 mg inj", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9060", "type": "HCPCS" }, { "code": "16729028838", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 416.00, "discounted_cash": 249.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cisplatin 50mg/50ml vial", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9060", "type": "HCPCS" }, { "code": "00143950401", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 88.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytoxan 500 mg", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J9074", "type": "HCPCS" }, { "code": "00781323394a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3955.00, "discounted_cash": 2373.00, "minimum": 4.30, "maximum": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 449.66, "10th_percentile": 189.17, "90th_percentile": 710.15, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytoxan 1 gm", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J9074", "type": "HCPCS" }, { "code": "00781324494a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7911.00, "discounted_cash": 4746.60, "minimum": 4.30, "maximum": 12.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 449.66, "10th_percentile": 189.17, "90th_percentile": 710.15, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cemiplimab-rwlc 350mg/7ml", "drug_information": { "unit": 350.00, "type": "ME" }, "code_information": [ { "code": "J9119", "type": "HCPCS" }, { "code": "61755000801A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43700.00, "discounted_cash": 26220.00, "minimum": 28.63, "maximum": 83.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14055.04, "10th_percentile": 14055.04, "90th_percentile": 14055.04, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 83.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 83.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 28.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Firmagon 240 mg", "drug_information": { "unit": 240.00, "type": "ME" }, "code_information": [ { "code": "J9155", "type": "HCPCS" }, { "code": "55566840301A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3742.00, "discounted_cash": 2245.20, "minimum": 4.32, "maximum": 12.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 12.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 12.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 4.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Taxotere 80 mg", "drug_information": { "unit": 80.00, "type": "ME" }, "code_information": [ { "code": "J9171", "type": "HCPCS" }, { "code": "00409036701a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3216.00, "discounted_cash": 1929.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Taxotere 20 mg", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J9171", "type": "HCPCS" }, { "code": "70121122101a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 172.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Imfinzi 500 mg", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J9173", "type": "HCPCS" }, { "code": "00310461150", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14880.00, "discounted_cash": 8928.00, "minimum": 83.03, "maximum": 243.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 243.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 243.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 83.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Padcev 20 mg", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J9177", "type": "HCPCS" }, { "code": "51144002001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9108.00, "discounted_cash": 5464.80, "minimum": 36.27, "maximum": 106.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 106.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 106.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 36.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Padcev 30 mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J9177", "type": "HCPCS" }, { "code": "51144003001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13662.00, "discounted_cash": 8197.20, "minimum": 36.27, "maximum": 106.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 106.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 106.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 36.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ellence 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9178", "type": "HCPCS" }, { "code": "00009509125a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 478.00, "discounted_cash": 286.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ellence 200 mg", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J9178", "type": "HCPCS" }, { "code": "00009509310a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2327.00, "discounted_cash": 1396.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Halaven 1mg/2ml vial", "drug_information": { "unit": 1.00, "type": "ME" }, "code_information": [ { "code": "J9179", "type": "HCPCS" }, { "code": "62856038901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5184.00, "discounted_cash": 3110.40, "minimum": 117.56, "maximum": 344.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 344.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 344.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 117.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Toposar 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9181", "type": "HCPCS" }, { "code": "68001026525", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 109.00, "discounted_cash": 65.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluorouracil 1 gm", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J9190", "type": "HCPCS" }, { "code": "63323011720", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 39.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluorouracil 5 gm", "drug_information": { "unit": 5000.00, "type": "ME" }, "code_information": [ { "code": "J9190", "type": "HCPCS" }, { "code": "63323011761a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 66.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gemzar 200 mg", "drug_information": { "unit": 200.00, "type": "ME" }, "code_information": [ { "code": "J9201", "type": "HCPCS" }, { "code": "71288011310", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 52.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gemzar 1 gm", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J9201", "type": "HCPCS" }, { "code": "71288011450", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 441.00, "discounted_cash": 264.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Poteligeo 20mg/5ml", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J9204", "type": "HCPCS" }, { "code": "42747076101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18026.00, "discounted_cash": 10815.60, "minimum": 241.19, "maximum": 707.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 707.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 707.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 241.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Onivyde 43mg/10ml", "drug_information": { "unit": 43.00, "type": "ME" }, "code_information": [ { "code": "J9205", "type": "HCPCS" }, { "code": "15054004301", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12516.00, "discounted_cash": 7509.60, "minimum": 64.63, "maximum": 189.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 189.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 189.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 64.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Camptosar 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9206", "type": "HCPCS" }, { "code": "61703034909", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 211.00, "discounted_cash": 126.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Camptosar 300 mg", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "J9206", "type": "HCPCS" }, { "code": "55150035401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1152.00, "discounted_cash": 691.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ixempra 15 mg", "drug_information": { "unit": 15.00, "type": "ME" }, "code_information": [ { "code": "J9207", "type": "HCPCS" }, { "code": "70020191001A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6630.00, "discounted_cash": 3978.00, "minimum": 134.85, "maximum": 395.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 395.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 395.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 134.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ixempra 45 mg", "drug_information": { "unit": 45.00, "type": "ME" }, "code_information": [ { "code": "J9207", "type": "HCPCS" }, { "code": "70020191101A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19890.00, "discounted_cash": 11934.00, "minimum": 134.85, "maximum": 395.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 395.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 395.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 134.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ifex 1 gm", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J9208", "type": "HCPCS" }, { "code": "10019092501A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 353.00, "discounted_cash": 211.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ifex 3 gm", "drug_information": { "unit": 3.00, "type": "GM" }, "code_information": [ { "code": "J9208", "type": "HCPCS" }, { "code": "10019092602A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1032.00, "discounted_cash": 619.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mesnex 1000 mg", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J9209", "type": "HCPCS" }, { "code": "00338130501A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 144.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lupron depot 22.5mg im syr kit", "drug_information": { "unit": 22.50, "type": "ME" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "00074334603", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18409.00, "discounted_cash": 11045.40, "minimum": 170.57, "maximum": 500.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 170.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1317.41, "10th_percentile": 1317.41, "90th_percentile": 1317.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leuprolide acetate susp 45mg", "drug_information": { "unit": 45.00, "type": "ME" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "00074347303", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41995.00, "discounted_cash": 25197.00, "minimum": 170.57, "maximum": 500.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 170.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1317.41, "10th_percentile": 1317.41, "90th_percentile": 1317.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eligard 22.5mg syringe", "drug_information": { "unit": 22.50, "type": "ME" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "62935022710a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1485.00, "discounted_cash": 891.00, "minimum": 170.57, "maximum": 500.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 170.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1317.41, "10th_percentile": 1317.41, "90th_percentile": 1317.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leuprolide acetate 45mg syr", "drug_information": { "unit": 45.00, "type": "ME" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "62935045345A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26017.00, "discounted_cash": 15610.20, "minimum": 170.57, "maximum": 500.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 170.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1317.41, "10th_percentile": 1317.41, "90th_percentile": 1317.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eligard 7.5mg syringe", "drug_information": { "unit": 7.50, "type": "ME" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "62935075680", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5203.00, "discounted_cash": 3121.80, "minimum": 170.57, "maximum": 500.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 500.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 170.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 1317.41, "10th_percentile": 1317.41, "90th_percentile": 1317.41, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lupron depot 30 mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J9218", "type": "HCPCS" }, { "code": "00074368303", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27996.00, "discounted_cash": 16797.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zepzelca 4 mg", "drug_information": { "unit": 4.00, "type": "ME" }, "code_information": [ { "code": "J9223", "type": "HCPCS" }, { "code": "68727071201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27593.00, "discounted_cash": 16555.80, "minimum": 202.99, "maximum": 595.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 595.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 595.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 3234.02, "10th_percentile": 3234.02, "90th_percentile": 3234.02, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 202.99, "count": "1 through 10", "median_amount": 13925.65, "10th_percentile": 13925.65, "90th_percentile": 13925.65, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 16607.28, "10th_percentile": 16607.28, "90th_percentile": 16607.28, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Yervoy 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9228", "type": "HCPCS" }, { "code": "00003232711", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30913.00, "discounted_cash": 18547.80, "minimum": 178.42, "maximum": 523.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 523.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 523.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 178.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methotrexate 1 gm", "drug_information": { "unit": 1.00, "type": "GM" }, "code_information": [ { "code": "J9260", "type": "HCPCS" }, { "code": "61703040841A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eloxatin oxaliplatin 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9263", "type": "HCPCS" }, { "code": "68001046836", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 576.00, "discounted_cash": 345.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxaliplatin 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9263", "type": "HCPCS" }, { "code": "68001046837", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1152.00, "discounted_cash": 691.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abraxane 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9264", "type": "HCPCS" }, { "code": "68817013450", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3069.00, "discounted_cash": 1841.40, "minimum": 12.93, "maximum": 37.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 37.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 37.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 12.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Taxol 30 mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J9267", "type": "HCPCS" }, { "code": "00703321301", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Taxol 100 mg", "drug_information": { "unit": 6.00, "type": "ME" }, "code_information": [ { "code": "J9267", "type": "HCPCS" }, { "code": "00703321601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 13.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Taxol 300 mg", "drug_information": { "unit": 300.00, "type": "ME" }, "code_information": [ { "code": "J9267", "type": "HCPCS" }, { "code": "00703321881a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1152.00, "discounted_cash": 691.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Keytruda 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9271", "type": "HCPCS" }, { "code": "00006302602", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22230.00, "discounted_cash": 13338.00, "minimum": 58.76, "maximum": 172.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 172.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 172.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 58.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 13507.05, "10th_percentile": 13507.05, "90th_percentile": 13507.05, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mutamycin 5 mg", "drug_information": { "unit": 5.00, "type": "ME" }, "code_information": [ { "code": "J9280", "type": "HCPCS" }, { "code": "25021025020a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2335.00, "discounted_cash": 1401.00, "minimum": 25.34, "maximum": 74.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 74.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 74.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 25.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mutamycin 20 mg", "drug_information": { "unit": 20.00, "type": "ME" }, "code_information": [ { "code": "J9280", "type": "HCPCS" }, { "code": "65219056620a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6067.00, "discounted_cash": 3640.20, "minimum": 25.34, "maximum": 74.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 74.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 74.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 25.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mutamycin 40 mg", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J9280", "type": "HCPCS" }, { "code": "71288013951a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5760.00, "discounted_cash": 3456.00, "minimum": 25.34, "maximum": 74.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 74.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 74.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 25.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Novantrone 25 mg", "drug_information": { "unit": 25.00, "type": "ME" }, "code_information": [ { "code": "J9293", "type": "HCPCS" }, { "code": "61703034365A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2071.00, "discounted_cash": 1242.60, "minimum": 27.41, "maximum": 80.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 80.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 80.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Novantrone 30 mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J9293", "type": "HCPCS" }, { "code": "61703034366A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2572.00, "discounted_cash": 1543.20, "minimum": 27.41, "maximum": 80.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 80.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 80.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Opdualag 240-80mg/20ml", "drug_information": { "unit": 240.00, "type": "ME" }, "code_information": [ { "code": "J9298", "type": "HCPCS" }, { "code": "00003712511", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62922.00, "discounted_cash": 37753.20, "minimum": 172.64, "maximum": 506.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 506.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 506.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 172.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Opdivo 240 mg", "drug_information": { "unit": 240.00, "type": "ME" }, "code_information": [ { "code": "J9299", "type": "HCPCS" }, { "code": "00003373413", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31772.00, "discounted_cash": 19063.20, "minimum": 32.03, "maximum": 93.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 93.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 93.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2568.80, "10th_percentile": 1883.79, "90th_percentile": 3253.81, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 32.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Opdivo 120mg/12ml", "drug_information": { "unit": 120.00, "type": "ME" }, "code_information": [ { "code": "J9299", "type": "HCPCS" }, { "code": "00003375614", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14389.00, "discounted_cash": 8633.40, "minimum": 32.03, "maximum": 93.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 93.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 93.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2568.80, "10th_percentile": 1883.79, "90th_percentile": 3253.81, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 32.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nivolumab 40mg/4ml", "drug_information": { "unit": 40.00, "type": "ME" }, "code_information": [ { "code": "J9299", "type": "HCPCS" }, { "code": "00003377211", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4990.00, "discounted_cash": 2994.00, "minimum": 32.03, "maximum": 93.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 93.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 93.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2568.80, "10th_percentile": 1883.79, "90th_percentile": 3253.81, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 32.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Obinutuzmab 1000mg/40ml", "drug_information": { "unit": 1000.00, "type": "ME" }, "code_information": [ { "code": "J9301", "type": "HCPCS" }, { "code": "50242007001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32967.00, "discounted_cash": 19780.20, "minimum": 74.46, "maximum": 218.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 218.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 218.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 74.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vectibex 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9303", "type": "HCPCS" }, { "code": "55513095401A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7173.00, "discounted_cash": 4303.80, "minimum": 163.27, "maximum": 478.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 478.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 478.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 163.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vectibex 400 mg", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "J9303", "type": "HCPCS" }, { "code": "55513095601A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28694.00, "discounted_cash": 17216.40, "minimum": 163.27, "maximum": 478.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 478.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 478.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 163.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alimta 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9305", "type": "HCPCS" }, { "code": "70069083401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1553.00, "discounted_cash": 931.80, "minimum": 3.73, "maximum": 10.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 10.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 10.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 372.56, "10th_percentile": 372.56, "90th_percentile": 372.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alimta 500 mg", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J9305", "type": "HCPCS" }, { "code": "70069083501a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1728.00, "discounted_cash": 1036.80, "minimum": 3.73, "maximum": 10.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 10.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 10.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 372.56, "10th_percentile": 372.56, "90th_percentile": 372.56, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyramza 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9308", "type": "HCPCS" }, { "code": "00002766901A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6003.00, "discounted_cash": 3601.80, "minimum": 72.64, "maximum": 212.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 212.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 212.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 72.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyramza 500 mg", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J9308", "type": "HCPCS" }, { "code": "00002767801A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30016.00, "discounted_cash": 18009.60, "minimum": 72.64, "maximum": 212.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 212.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 212.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 72.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polivy 30mg vial", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J9309", "type": "HCPCS" }, { "code": "50242010301", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15037.00, "discounted_cash": 9022.20, "minimum": 131.40, "maximum": 385.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 385.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 385.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 131.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polivy 140mg vial", "drug_information": { "unit": 140.00, "type": "ME" }, "code_information": [ { "code": "J9309", "type": "HCPCS" }, { "code": "50242010501", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70172.00, "discounted_cash": 42103.20, "minimum": 131.40, "maximum": 385.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 385.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 385.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 131.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rituximab 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9312", "type": "HCPCS" }, { "code": "50242005121", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3758.00, "discounted_cash": 2254.80, "minimum": 75.67, "maximum": 221.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 221.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 221.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 75.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rituxan 500 mg inj", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J9312", "type": "HCPCS" }, { "code": "50242005306", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18790.00, "discounted_cash": 11274.00, "minimum": 75.67, "maximum": 221.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 221.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 221.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 75.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sacituzumab gv-hziy 180mg/20ml", "drug_information": { "unit": 180.00, "type": "ME" }, "code_information": [ { "code": "J9317", "type": "HCPCS" }, { "code": "55135013201", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10459.00, "discounted_cash": 6275.40, "minimum": 35.44, "maximum": 103.91, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 103.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 103.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Torisel 30 mg", "drug_information": { "unit": 30.00, "type": "ME" }, "code_information": [ { "code": "J9330", "type": "HCPCS" }, { "code": "72611078502A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4306.00, "discounted_cash": 2583.60, "minimum": 30.02, "maximum": 88.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 88.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 88.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 30.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zynyz 500mg/20ml vial", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "J9345", "type": "HCPCS" }, { "code": "50881000603", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60152.00, "discounted_cash": 36091.20, "minimum": 26.45, "maximum": 77.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 77.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 77.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 26.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kadcyla 160mg", "drug_information": { "unit": 160.00, "type": "ME" }, "code_information": [ { "code": "J9354", "type": "HCPCS" }, { "code": "50242008701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22488.00, "discounted_cash": 13492.80, "minimum": 40.70, "maximum": 119.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 119.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 119.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 40.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kadcyla 100mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "J9354", "type": "HCPCS" }, { "code": "50242008801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14055.00, "discounted_cash": 8433.00, "minimum": 40.70, "maximum": 119.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 119.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 119.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 40.70, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Velban 1 mg", "drug_information": { "unit": 10.00, "type": "ME" }, "code_information": [ { "code": "J9360", "type": "HCPCS" }, { "code": "63323027810", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 588.00, "discounted_cash": 352.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vincristine 2 mg", "drug_information": { "unit": 2.00, "type": "ME" }, "code_information": [ { "code": "J9370", "type": "HCPCS" }, { "code": "61703030916", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 182.00, "discounted_cash": 109.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 14.48, "10th_percentile": 14.48, "90th_percentile": 14.48, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Navelbine 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "J9390", "type": "HCPCS" }, { "code": "25021020405", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 864.00, "discounted_cash": 518.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Faslodex 250 mg", "drug_information": { "unit": 250.00, "type": "ME" }, "code_information": [ { "code": "J9395", "type": "HCPCS" }, { "code": "70121146302A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 792.00, "discounted_cash": 475.20, "minimum": 6.83, "maximum": 20.03, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 20.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 20.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 6.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hallux implant", "code_information": [ { "code": "L8642", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 8159.75, "discounted_cash": 4895.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bs infinion 16 tri lead kit 50", "code_information": [ { "code": "L8680", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 5276.00, "discounted_cash": 3165.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2210.00, "10th_percentile": 2210.00, "90th_percentile": 2210.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Implt neurostim elctr each", "code_information": [ { "code": "L8680", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 5276.00, "discounted_cash": 3165.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 2210.00, "10th_percentile": 2210.00, "90th_percentile": 2210.00, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone cement mixer pk hv-r", "code_information": [ { "code": "L8699", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 526.50, "discounted_cash": 315.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 113.51, "10th_percentile": 113.51, "90th_percentile": 113.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.97, "10th_percentile": 127.97, "90th_percentile": 127.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prosthetic implant nos", "code_information": [ { "code": "L8699", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 526.50, "discounted_cash": 315.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 113.51, "10th_percentile": 113.51, "90th_percentile": 113.51, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 127.97, "10th_percentile": 127.97, "90th_percentile": 127.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adm tocilizu covid-19 1st", "code_information": [ { "code": "M0249", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1043.50, "discounted_cash": 626.10, "minimum": 400.72, "maximum": 1174.89, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1174.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1174.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 400.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adm tocilizumab 400mg covid", "code_information": [ { "code": "M0249", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1043.50, "discounted_cash": 626.10, "minimum": 400.72, "maximum": 1174.89, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1174.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1174.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 400.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pap screen slide", "code_information": [ { "code": "P3000", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 286.00, "discounted_cash": 171.60, "minimum": 18.01, "maximum": 52.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 52.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 52.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 18.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Screen pap by tech w md supv", "code_information": [ { "code": "P3000", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 286.00, "discounted_cash": 171.60, "minimum": 18.01, "maximum": 52.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 52.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 52.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 18.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leukoreduced packed cells", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 694.75, "discounted_cash": 416.85, "minimum": 161.89, "maximum": 474.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 646.12, "10th_percentile": 646.12, "90th_percentile": 646.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 474.65, "count": "1 through 10", "median_amount": 636.90, "10th_percentile": 545.10, "90th_percentile": 728.70, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 474.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 741.43, "10th_percentile": 741.43, "90th_percentile": 741.43, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 74.89, "10th_percentile": 68.09, "90th_percentile": 149.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 161.89, "count": "1 through 10", "median_amount": 304.52, "10th_percentile": 223.31, "90th_percentile": 385.73, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 409.13, "10th_percentile": 254.12, "90th_percentile": 564.15, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 200.97, "10th_percentile": 200.97, "90th_percentile": 200.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1280.01, "10th_percentile": 1280.01, "90th_percentile": 1280.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1280.01, "10th_percentile": 1280.01, "90th_percentile": 1280.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.98, "10th_percentile": 188.98, "90th_percentile": 188.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc leukocytes reduced", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 694.75, "discounted_cash": 416.85, "minimum": 161.89, "maximum": 474.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 646.12, "10th_percentile": 646.12, "90th_percentile": 646.12, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 474.65, "count": "1 through 10", "median_amount": 636.90, "10th_percentile": 545.10, "90th_percentile": 728.70, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 474.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 741.43, "10th_percentile": 741.43, "90th_percentile": 741.43, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "11", "median_amount": 74.89, "10th_percentile": 68.09, "90th_percentile": 149.79, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 161.89, "count": "1 through 10", "median_amount": 304.52, "10th_percentile": 223.31, "90th_percentile": 385.73, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 409.13, "10th_percentile": 254.12, "90th_percentile": 564.15, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 200.97, "10th_percentile": 200.97, "90th_percentile": 200.97, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1280.01, "10th_percentile": 1280.01, "90th_percentile": 1280.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 1280.01, "10th_percentile": 1280.01, "90th_percentile": 1280.01, "methodology": "percent of total billed charges" }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 188.98, "10th_percentile": 188.98, "90th_percentile": 188.98, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fresh frozen plasma", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 244.75, "discounted_cash": 146.85, "minimum": 74.98, "maximum": 219.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 219.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 219.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 74.98, "count": "1 through 10", "median_amount": 286.03, "10th_percentile": 286.03, "90th_percentile": 286.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Plasma 1 donor frz w/in 8 hr", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 244.75, "discounted_cash": 146.85, "minimum": 74.98, "maximum": 219.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 219.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 219.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 74.98, "count": "1 through 10", "median_amount": 286.03, "10th_percentile": 286.03, "90th_percentile": 286.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelet pheres leukoreduced", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1438.25, "discounted_cash": 862.95, "minimum": 433.28, "maximum": 1270.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1270.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1270.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 433.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 445.86, "10th_percentile": 445.86, "90th_percentile": 445.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 873.89, "10th_percentile": 873.89, "90th_percentile": 873.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelet pheresis-prp", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1438.25, "discounted_cash": 862.95, "minimum": 433.28, "maximum": 1270.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1270.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1270.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 433.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 445.86, "10th_percentile": 445.86, "90th_percentile": 445.86, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 873.89, "10th_percentile": 873.89, "90th_percentile": 873.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc leukoreduced irradiated", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 997.50, "discounted_cash": 598.50, "minimum": 227.54, "maximum": 667.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 667.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 667.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 227.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 454.57, "10th_percentile": 333.35, "90th_percentile": 575.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Red blood cells leukocytes irr", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 997.50, "discounted_cash": 598.50, "minimum": 227.54, "maximum": 667.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 667.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 667.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 227.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 454.57, "10th_percentile": 333.35, "90th_percentile": 575.79, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albumin (human) 25% 50ml", "code_information": [ { "code": "P9047", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 472.50, "discounted_cash": 283.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 358.88, "10th_percentile": 186.62, "90th_percentile": 531.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albumin infusion 25% 50 ml", "code_information": [ { "code": "P9047", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 472.50, "discounted_cash": 283.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 358.88, "10th_percentile": 186.62, "90th_percentile": 531.13, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelet pheresis-prp", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1438.25, "discounted_cash": 862.95, "minimum": 522.39, "maximum": 1531.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1531.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1531.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 522.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 873.89, "10th_percentile": 873.89, "90th_percentile": 873.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelets pheresis path redu", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1438.25, "discounted_cash": 862.95, "minimum": 522.39, "maximum": 1531.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 1531.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 1531.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 522.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 873.89, "10th_percentile": 873.89, "90th_percentile": 873.89, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cath for specimen collection", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11.75, "discounted_cash": 7.05, "minimum": 9.00, "maximum": 26.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 26.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 26.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 9.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Catheterize for urine spec", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11.75, "discounted_cash": 7.05, "minimum": 9.00, "maximum": 26.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 26.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 26.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 9.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferahenme 510mg/17ml vial (iv)", "drug_information": { "unit": 510.00, "type": "ME" }, "code_information": [ { "code": "Q0138", "type": "HCPCS" }, { "code": "00781315401a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 715.00, "discounted_cash": 429.00, "minimum": 0.33, "maximum": 0.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 0.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 0.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 0.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 194.57, "10th_percentile": 194.57, "90th_percentile": 194.57, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tocilizumab 400 mg covid 19", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "Q0238", "type": "HCPCS" }, { "code": "50242013701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8070.00, "discounted_cash": 4842.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fosphenytoin 500mg/10ml vial", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "Q2009", "type": "HCPCS" }, { "code": "00069600121A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 212.00, "discounted_cash": 127.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fosphenytoin 100 mg/2ml vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "Q2009", "type": "HCPCS" }, { "code": "00069600125A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 232.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxil 50 mg", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "Q2050", "type": "HCPCS" }, { "code": "43598054125a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5979.00, "discounted_cash": 3587.40, "minimum": 148.91, "maximum": 436.58, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 436.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 436.58, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 148.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Telehealth facility fee", "code_information": [ { "code": "Q3014", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 60.25, "discounted_cash": 36.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 91.53, "10th_percentile": 91.53, "90th_percentile": 91.53, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apligraf", "code_information": [ { "code": "Q4101", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11187.50, "discounted_cash": 6712.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apligraf skin sub per sq cm 44", "code_information": [ { "code": "Q4101", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 11187.50, "discounted_cash": 6712.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Puraply am 1 sq cm", "code_information": [ { "code": "Q4196", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6250.00, "discounted_cash": 3750.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Puraply am 5x5 cm", "code_information": [ { "code": "Q4196", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6250.00, "discounted_cash": 3750.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Infliximab-dyyb 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "Q5103", "type": "HCPCS" }, { "code": "00069080901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9084.00, "discounted_cash": 5450.40, "minimum": 15.75, "maximum": 46.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 46.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 46.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 15.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epoetin alfa-epbx 20000 un", "drug_information": { "unit": 20000.00, "type": "UN" }, "code_information": [ { "code": "Q5106", "type": "HCPCS" }, { "code": "00069131101", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2118.00, "discounted_cash": 1270.80, "minimum": 7.00, "maximum": 20.52, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 20.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 20.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 7.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mvasi 100 mg", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "Q5107", "type": "HCPCS" }, { "code": "55513020601", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2656.00, "discounted_cash": 1593.60, "minimum": 29.52, "maximum": 86.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 86.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 86.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5780.09, "10th_percentile": 5780.09, "90th_percentile": 5780.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 29.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mvasi 400 mg", "drug_information": { "unit": 400.00, "type": "ME" }, "code_information": [ { "code": "Q5107", "type": "HCPCS" }, { "code": "55513020701", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10623.00, "discounted_cash": 6373.80, "minimum": 29.52, "maximum": 86.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 86.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 86.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 5780.09, "10th_percentile": 5780.09, "90th_percentile": 5780.09, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 29.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kanjinti 420 mg", "drug_information": { "unit": 420.00, "type": "ME" }, "code_information": [ { "code": "Q5117", "type": "HCPCS" }, { "code": "55513013201A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14495.00, "discounted_cash": 8697.00, "minimum": 27.63, "maximum": 81.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 81.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 81.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kanjinti 150 mg", "drug_information": { "unit": 150.00, "type": "ME" }, "code_information": [ { "code": "Q5117", "type": "HCPCS" }, { "code": "55513014101A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5177.00, "discounted_cash": 3106.20, "minimum": 27.63, "maximum": 81.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 81.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 81.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 27.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ruxience 500mg vial", "drug_information": { "unit": 500.00, "type": "ME" }, "code_information": [ { "code": "Q5119", "type": "HCPCS" }, { "code": "00069024901", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10786.00, "discounted_cash": 6471.60, "minimum": 24.69, "maximum": 72.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 72.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 72.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 634.25, "10th_percentile": 295.99, "90th_percentile": 972.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 24.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ruxience 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "Q5119", "type": "HCPCS" }, { "code": "00069023801", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2157.00, "discounted_cash": 1294.20, "minimum": 24.69, "maximum": 72.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 72.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 72.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 634.25, "10th_percentile": 295.99, "90th_percentile": 972.51, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 24.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Avsola 100mg vial", "drug_information": { "unit": 100.00, "type": "ME" }, "code_information": [ { "code": "Q5121", "type": "HCPCS" }, { "code": "55513067001", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4800.00, "discounted_cash": 2880.00, "minimum": 19.55, "maximum": 57.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 57.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 57.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 19.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gastrografin 30ml oral contras", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "Q9963", "type": "HCPCS" }, { "code": "00270044535", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 222.00, "discounted_cash": 133.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Omnipaque 150ml iv contrast", "drug_information": { "unit": 150.00, "type": "ML" }, "code_information": [ { "code": "Q9965", "type": "HCPCS" }, { "code": "00407141493", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1651.00, "discounted_cash": 990.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Locm 100-199mg/ml iodine1ml", "code_information": [ { "code": "Q9965", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 290.75, "discounted_cash": 174.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Low os contrast 150-199 mg/ml", "code_information": [ { "code": "Q9965", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 290.75, "discounted_cash": 174.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Omnipaque 240mg/ml", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "Q9966", "type": "HCPCS" }, { "code": "00407141210A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 603.00, "discounted_cash": 361.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 394.94, "10th_percentile": 146.01, "90th_percentile": 541.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 296.94, "10th_percentile": 296.94, "90th_percentile": 296.94, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 65.00, "10th_percentile": 59.09, "90th_percentile": 65.00, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.55, "10th_percentile": 146.55, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 183.20, "10th_percentile": 109.92, "90th_percentile": 183.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.02, "10th_percentile": 164.02, "90th_percentile": 164.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 444.38, "10th_percentile": 444.38, "90th_percentile": 444.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 444.38, "10th_percentile": 444.38, "90th_percentile": 444.38, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Locm 200-299mg/ml iodine 1 ml", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "Q9966", "type": "HCPCS" }, { "code": "00270141111A", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 394.94, "10th_percentile": 146.01, "90th_percentile": 541.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 296.94, "10th_percentile": 296.94, "90th_percentile": 296.94, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 65.00, "10th_percentile": 59.09, "90th_percentile": 65.00, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.55, "10th_percentile": 146.55, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 183.20, "10th_percentile": 109.92, "90th_percentile": 183.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.02, "10th_percentile": 164.02, "90th_percentile": 164.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 444.38, "10th_percentile": 444.38, "90th_percentile": 444.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 444.38, "10th_percentile": 444.38, "90th_percentile": 444.38, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Isovue-m 200 20 ml vial", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "Q9966", "type": "HCPCS" }, { "code": "00270141125", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 61.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "37", "median_amount": 394.94, "10th_percentile": 146.01, "90th_percentile": 541.94, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 296.94, "10th_percentile": 296.94, "90th_percentile": 296.94, "methodology": "percent of total billed charges" }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "31", "median_amount": 65.00, "10th_percentile": 59.09, "90th_percentile": 65.00, "methodology": "percent of total billed charges" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 146.55, "10th_percentile": 146.55, "90th_percentile": 146.55, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "25", "median_amount": 183.20, "10th_percentile": 109.92, "90th_percentile": 183.20, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 164.02, "10th_percentile": 164.02, "90th_percentile": 164.02, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 444.38, "10th_percentile": 444.38, "90th_percentile": 444.38, "methodology": "percent of total billed charges" }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "1 through 10", "median_amount": 444.38, "10th_percentile": 444.38, "90th_percentile": 444.38, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methylene blue 10mg/ml 10ml vi", "drug_information": { "unit": 50.00, "type": "ME" }, "code_information": [ { "code": "Q9968", "type": "HCPCS" }, { "code": "00517037405a", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 1350.00, "minimum": 7.50, "maximum": 22.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 22.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 22.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 7.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Covid-19 lab test non-cdc", "code_information": [ { "code": "U0002", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 677.75, "discounted_cash": 406.65, "minimum": 50.80, "maximum": 148.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 168.08, "10th_percentile": 132.49, "90th_percentile": 206.07, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 148.93, "count": "12", "median_amount": 457.69, "10th_percentile": 311.41, "90th_percentile": 556.67, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 148.93, "count": "1 through 10", "median_amount": 484.69, "10th_percentile": 484.69, "90th_percentile": 484.69, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 238.62, "10th_percentile": 158.61, "90th_percentile": 513.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 199.26, "10th_percentile": 129.36, "90th_percentile": 199.26, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 50.80, "count": "1 through 10", "median_amount": 198.03, "10th_percentile": 160.24, "90th_percentile": 198.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.03, "10th_percentile": 196.03, "90th_percentile": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 196.03, "10th_percentile": 129.21, "90th_percentile": 205.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nfct agent dna/rna gi 3-5 targ", "code_information": [ { "code": "U0002", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 677.75, "discounted_cash": 406.65, "minimum": 50.80, "maximum": 148.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 168.08, "10th_percentile": 132.49, "90th_percentile": 206.07, "methodology": "percent of total billed charges" }, { "payer_name": "Highmark Bc Bs Of Wv", "plan_name": "BCMS", "standard_charge_dollar": 148.93, "count": "12", "median_amount": 457.69, "10th_percentile": 311.41, "90th_percentile": 556.67, "methodology": "fee schedule" }, { "payer_name": "Highmark Bc Bs Of Wv (Other)", "plan_name": "BC/OTH", "standard_charge_dollar": 148.93, "count": "1 through 10", "median_amount": 484.69, "10th_percentile": 484.69, "90th_percentile": 484.69, "methodology": "fee schedule" }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 238.62, "10th_percentile": 158.61, "90th_percentile": 513.46, "methodology": "percent of total billed charges" }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "20", "median_amount": 199.26, "10th_percentile": 129.36, "90th_percentile": 199.26, "methodology": "percent of total billed charges" }, { "payer_name": "Mountain State Freedom Blue", "plan_name": "BCMS/MCR_1", "standard_charge_dollar": 50.80, "count": "1 through 10", "median_amount": 198.03, "10th_percentile": 160.24, "90th_percentile": 198.03, "methodology": "fee schedule" }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "1 through 10", "median_amount": 196.03, "10th_percentile": 196.03, "90th_percentile": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "14", "median_amount": 196.03, "10th_percentile": 129.21, "90th_percentile": 205.90, "methodology": "percent of total billed charges" }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clareon toric uv iol 18.0d", "code_information": [ { "code": "V2511", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1443.75, "discounted_cash": 866.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cntct toric prism ballast", "code_information": [ { "code": "V2511", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1443.75, "discounted_cash": 866.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intraocular lens post chamber", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 545.75, "discounted_cash": 327.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Post chmbr intraocular lens", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 545.75, "discounted_cash": 327.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Astigmatism-correct function", "code_information": [ { "code": "V2787", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 644.50, "discounted_cash": 386.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intraocular lens toric astig", "code_information": [ { "code": "V2787", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 644.50, "discounted_cash": 386.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna", "plan_name": "AETNA", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna", "plan_name": "AETNA_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Open Plan", "plan_name": "AETNA/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Hmo Medicare", "plan_name": "HMO/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Choice Ppo", "plan_name": "HUMANAPPO_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Gold Choice", "plan_name": "HUMANAGC_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "The Health Plan Medicare", "plan_name": "THP/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Medicare Advantage", "plan_name": "UHC/MCR_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr", "plan_name": "UMR_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Umr Peia", "plan_name": "AN/PEIA_1", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Health Care", "plan_name": "UHC_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] } ] }